A2DS2 versus AIS-APS for Stroke-Associated Pneumonia in Acute Ischemic Stroke: A Prospective Validation Study
DOI:
https://doi.org/10.26911/theijmed.2026.11.4.991Abstract
Background: Stroke-associated pneumonia (SAP) is a frequent early complication of acute stroke. This study compared the prognostic performance of A2DS2 and the Acute Ischemic Stroke-Associated Pneumonia Score (AIS-APS) in first-ever acute ischemic stroke.
Subjects and Method: This prospective prognostic validation study consecutively enrolled 45 patients at Dr. Moewardi General Hospital, Surakarta, Indonesia, beginning in May 2026 and continuing until the planned sample was completed. Both scores were calculated at hospital admission before final SAP adjudication, and patients were observed through day 7 after stroke onset. SAP was classified using PISCES/mCDC criteria. Discrimination was assessed using paired ROC analysis and the DeLong test; cut-offs were selected by the Youden index, paired classification was compared using exact McNemar testing, and each score was examined in a separate univariable logistic regression model.
Results: SAP occurred in 31/45 patients (68.9%). A2DS2 was higher in SAP than non-SAP patients (median 7.00, IQR 1.00 vs. 3.50, IQR 4.00; p<0.001), as was AIS-APS (mean 18.45, SD 3.20 vs. 8.50, SD 4.33; p<0.001). AUCs were 0.98 (95% CI 0.96 to 1.00) for A2DS2 and 0.98 (95% CI 0.94 to 1.00) for AIS-APS (ΔAUC=0.01; 95% CI -0.03 to 0.05; p=0.655). At study-derived cut-offs, A2DS2 ≥7 had 93.5% sensitivity and 100.0% specificity, while AIS-APS ≥16 had 90.3% sensitivity and 92.9% specificity; classification accuracy did not differ (McNemar p=0.625).
Conclusion: A2DS2 and AIS-APS showed similarly high discrimination in this single-center cohort. The study-derived cut-offs require external validation before routine clinical implementation.
Keywords:
A2DS2, AIS-APS, ischemic stroke, prognostic validation, pneumonia
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References
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