Association between stress hyperglycemia and pneumonia in patients with stroke: a systematic review and meta-analysis
Bibliographic record
Abstract
BACKGROUND: Pneumonia is a frequent complication post-stroke and stress hyperglycemia (SH) is a physiological response to stroke. Although some studies have provided data on the impact of stress hyperglycemia on pneumonia incidence, no study to date has exclusively focused on investigating the direct relationship between stress hyperglycemia and pneumonia. METHODS: A comprehensive literature search was conducted across PubMed, EBSCOhost, Web of Science, Embase, CNKI, and Wanfang databases from inception to July 10th, 2024, to identify observational studies comparing the incidence of pneumonia between stroke patients with and without stress hyperglycemia. The methodological quality of the included studies was assessed using the Newcastle-Ottawa Scale (NOS), and pooled ORs for each comparison were estimated using a random-effects model proposed by DerSimonian and Kacker. This systematic review is presented in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines. RESULTS: Twelve studies were included eventually and the pooled incidence rate of pneumonia was 14.4%. The overall incidence of pneumonia in patients with stress hyperglycemia was significantly higher than in those without stress hyperglycemia (OR: 2.01; 95% CI: 1.72 to 2.34, P < 0.01).Significant heterogeneity was observed in the meta-analysis (P = 0.01, I²=54%). Meta-regression revealed that the effect size differed significantly across subgroups defined by SH metrics (blood glucose versus stress hyperglycemia ratio and blood glucose to HbA1c ratio, p < 0.01). These findings underscore important limitations, including measurement variability, significant heterogeneity, and potential residual confounding due to factors such as dysphagia severity, comorbidity burden, and variations in clinical management. Importantly, the overall quality of evidence was rated as low based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework, primarily due to the observational design of the included studies and inconsistency across results. Therefore, the findings should be interpreted cautiously and regarded as hypothesis-generating. CONCLUSIONS: This systematic review and meta-analysis found that SH was significantly associated with post-stroke pneumonia, with patients exhibiting SH having twice the odds of pneumonia compared to those without. PROSPECTIVE REGISTRATION: The protocol for this review is registered with the International Prospective Register of Systematic Reviews (PROSPERO) under the registration number CRD42024563263.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.028 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.018 | 0.045 |
| Bibliometrics | 0.007 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".