Stroke-Associated Pneumonia and Impaired Functional Recovery After Stroke: The Role of Nutritional-Inflammatory Factors

Background: Stroke-associated pneumonia (SAP) is a common complication after acute ischemic stroke and contributes to worse recovery and greater resource use. Nutritional and inflammatory dysregulation have been implicated in both SAP susceptibility and adverse prognosis. Objective: To examine whether admission inflammatory and nutritional markers are associated with the development of SAP and with short-term functional prognosis. Methods: We performed a retrospective single-centre cohort study of consecutive patients with acute ischemic stroke admitted between 1 January 2015 and 31 December 2024 (N=303;SAPn=108,non−SAPn=195). Admission laboratory indices (albumin, CRP, fibrinogen, WBC, PCT, and prealbumin) in the first 24 h and clinical variables were analysed. Multivariable logistic regression identified factors independently associated with SAP; the relationship between SAP and early functional recovery was assessed in adjusted outcome models. A nomogram integrating key predictors was developed and its apparent discrimination is reported. Results: SAP occurred in 35.6% of patients. Factors independently associated with SAP included nasogastric tube placement (OR: 7.02, 95% CI: 3.50–14.62), venous thromboembolism (OR: 3.20, 95% CI: 1.62–6.31), cognitive impairment (OR: 2.90, 95% CI: 1.32–6.36), and elevated inflammatory markers (WBC OR: 1.52, 95% CI: 1.28–1.80; fibrinogen OR: 1.37, 95% CI: 1.02–1.84; CRP OR: 1.01, 95% CI: 1.00–1.03). Higher admission serum albumin was associated with lower odds of SAP (OR: 0.92, 95% CI: 0.86–0.98). The nomogram showed strong apparent discrimination (AUC: 0.90, 95% CI: 0.86–0.94). After multivariable adjustment, SAP remained associated with poorer short-term functional improvement (adjusted OR: 6.99, 95% CI: 3.05–17.54) and greater healthcare utilization (median length of stay: 39.6 vs. 30.6 days; median cost: USD 12,836 vs. 6585). Conclusion: In this retrospective cohort, admission markers of nutritional depletion and inflammatory activation were associated not only with increased likelihood of SAP, but also with adverse early functional outcomes. These association-based findings support early risk stratification using routine admission markers; prospective studies and external validation are required before clinical implementation.