Perbandingan Tingkat Akurasi Kadar Interleukin-6, Neutrophil Lymphocyte Ratio dan Skor A2DS2 sebagai Prediktor Stroke-Associated Pneumonia pada Pasien Stroke Iskemik Akut

Abstract

Background: Stroke-associated pneumonia (SAP) is a common and feared complication after acute stroke. Stroke-associated pneumonia most often occurs in the first week. Reportedly, 15-25% of stroke patients die from stroke-associated pneumonia, a common complication of acute ischemic stroke. Stroke causes immunosuppression, increasing the risk of infection. Interleukin-6 (IL-6) and the Neutrophil Lymphocyte Ratio (NLR) are inflammatory markers associated with a poor prognosis. The A2DS2 score is often used to predict post-stroke pneumonia due to its simplicity and accuracy. Objective: To compare the accuracy of IL-6 levels, NLR, and the A2DS2 score as predictors of SAP in patients with acute ischemic stroke. Methods: This observational analytical study with a prospective cohort design was conducted at Adam Malik Hospital, Medan, from June to November 2025. Subjects were acute ischemic stroke patients who met the inclusion and exclusion criteria. Data were collected through examination of IL-6 levels, NLR, and A2DS2 scores on the first day of admission and assessing the incidence of SAP. Univariate analysis was performed to describe the data. The predictive accuracy of IL-6, NLR, and A2DS2 against SAP was assessed using the ROC curve. Bivariate analysis used the chi-square and Fisher exact tests. Multivariate analysis used the logistic regression test. Results: A total of 50 subjects were included in this study with a mean age of 61.36 ± 10.84 years. IL-6 levels had a sensitivity of 86,7%, specificity of 85,7%, and an Area Under Curve (AUC) of 86,3%. NLR had a sensitivity of 80%, specificity of 80%, and an AUC of 85,5%. A2DS2 scores had a sensitivity of 80%, specificity of 91,4%, and an AUC of 87,1%. Based on multivariate analysis, IL-6 levels and A2DS2 scores were significant predictors of SAP in acute ischemic stroke patients. Conclusion: IL-6 levels and A2DS2 scores were significant predictors of SAP in acute ischemic stroke patients.