Role of C-reactive protein and fibreoptic endoscopic evaluation of swallowing as early markers of stroke-associated pneumonia.

Abstract

Introduction: Stroke may result in dysphagia, which can subsequently lead to stroke-associated pneumonia (SaP). This condition has been shown to exert a significant negative impact on patient outcome. Early diagnosis and prevention are therefore desirable.

Methods: This retrospective study compared inflammatory markers during the first 4 days after stroke in 515 patients from 2015 and 2021, analyzing associations with dysphagia, year of treatment, dietary adjustments, stroke-associated pneumonia, and antibiotic use. Data entry and descriptive analyses were performed using Microsoft Excel^®. Datasets from 2015 and 2021 were analyzed in SPSS^® (IBM SPSS Statistics 27).

Results: This retrospective analysis demonstrates that dysphagia significantly influences C-reactive protein (CRP) levels within the first 4 days after stroke. Dysphagia and elevated CRP are early markers of emergence of stroke-associated pneumonia, whereas leukocyte count and temperature show limited forewarning value. The combination of post-stroke inflammatory response, dysphagia (PAS > 5), and elevated CRP may serve as an early indicator of SaP and support timely FEES-based assessment.

Discussion: Early elevated CRP levels in dysphagic stroke patients are indicative of aspiration-related inflammation and may serve as a sensitive early biomarker for stroke-associated pneumonia. The combined assessment of dysphagia severity and CRP supports improved early risk stratification and preventive management.