JOURNAL REVIEW

STROKE IN THE ACUTE PERIOD

(writted for Critical Care System II task)

LECTURER :

Reni Prima Gusty, S.Kp, M.Kes

WRITTEN BY :

BOBBY DWI PUTERA (1511314009)

NURSING FACULTY

ANDALAS UNIVERSITY

2018/2019
 PREFACE
Praise be to Allah SWT who has helped his servant finish this paper with full ease.
Without his help authors may not be able to finish it. The paper is structured so that the reader
can expand the knowledge about The journal that explain “Prognostic Factors for Stroke
Associated Infection (SAI) in Acute Ischemic Stroke Patients”, which i present is based on
observations from a variety of sources. This paper was prepared by the authors with many
obstacles. Both coming from self-constituent or from the outside. But with patience and
especially the help of Allah, the paper finally be resolved.

Although this paper is not perfect, but it works fairly clear detail and language that is
easily understood by the reader. Our thanks goes to lecturer of Critical Care System II that has
guided us and all those who have helped author of this paper finish. Hopefully this paper can
provide greater insight to the reader. We realize this paper has advantages and disadvantages,
constituent beg for advice and criticism. Thank you.

Padang, September 15, 2018

Authors

A. Preliminary

Stroke is a major health problem. Stroke is the third cause of death (after heart disease
and cancer), and the number one cause of disability.

Early identification of prognostic factors in the occurrence of stroke associated infection (SAI) in
patients with acute ischemic stroke is very important to prevent the occurrence of nosocomial infection
 so that it will aggravate and worsen the output of patients with acute ischemic stroke. A study states that
nearly 85% of stroke patients experience complications during acute phase treatment.

Prognostic factors that can affect the occurrence of SAI but there are currently no models
that can predict the occurrence of SAI, it is necessary to study to determine the prognostic factors
of stroke associated infection (SAI) in patients with acute ischemic stroke so as to reduce sufferers
morbidity and mortality stroke patient.

On that basis, it was thought to create a journal review of a journal entitled “Prognostic
Factors for Stroke Associated Infection (SAI) in Acute Ischemic Stroke Patients” we choose to
complete the task of review of journal about Critical Care System II. Surely this paper is not the
Word of God therefore we try to criticize the journal both from different points of view.

B. JOURNAL SUMMARY
1. Journal identity
Title Prognostic Factors for Stroke Associated Infection (SAI) in
Acute Ischemic Stroke Patients
Writter Ilsa Hunaifi, dkk
Publish Year 2016

2. Journal Conclusion
a. Preliminary
Stroke is the fourth largest cause of death in the United States. An estimated 6.8 million people
have a stroke, 610 thousand new stroke cases each year and 87% are ischemic strokes. 1 In Indonesia, the
Ministry of Health reports that stroke is a major cause of death and disability in all hospitals in Indonesia
with a mortality rate of around 15% and a disability rate reaching 65%.

One complication of stroke is infection. Hospital-acquired infections or nosocomial infections are

the main causes of morbidity and mortality in patients with acute ischemic stroke. Infection complications,
especially the airways and urinary tract, have been reported in 23-65% of stroke patients in the early days
after stroke onset. Pneumonia is reported in 7-22% of stroke patients, where dysphagia and aspiration are
the most important factors.

Prognostic factors that can affect the occurrence of SAI but there are currently no models
that can predict the occurrence of SAI, it is necessary to study to determine the prognostic factors
of stroke associated infection (SAI) in patients with acute ischemic stroke so as to reduce sufferers
morbidity and mortality stroke patient.

b. Method
This research is analytic observational in nature with a retrospective cohort design. The
population of this study were patients who were treated in Mataram City Hospital with acute
ischemic stroke between April 2015 and the number of samples. Inclusion criteria are (1) Sufferers
acute ischemic stroke, (2) no infection (wound, heat) within 1 week before the stroke, (3) no use
of imonusuppressive drugs (corticosteroids, chemotherapy), while the exclusion criteria were died
during the study period and suffered HIV / AIDS infection. The variables studied are age, gender,
NIHSS scale, diabetes mellitus, leucocyte count, dysphagia, infarct location, picture chest X-ray,
atrial fibrillation, congestive heart failure. Data analysis used logistic regression with SPSS 21.0.
c. Processing and analysis of data
The mean age of the study subjects was 60.37 ± 10.51 years. In the SAI group, the mean
age was 62.11 ± 11, 20 years, while in the group that did not experience SAI was 57.84 ± 8.93
years. From the bivariate analysis, age was associated with SAI (p = 0.039), dysphagia was
associated with SAI (p = 0.000), infarct location affected SAI (p = 0.02), chest X-ray abnormalities
and congestive heart failure affected SAI ( p = 0,000, p = 0,001). Multivariate analysis of each
variable is continued with the textless p requirement of 0.25. From the results of the analysis it
was found that the prognostic factors that most contribute to the occurrence of SAI are sex, chest
X-ray, dysphagia and congestive heart failure.

C. RESULTS
In the demographic characteristics of the study subjects, there were no significant
differences in demographic data including age, sex, clinical severity measured by the NIHSS
scale, Diabetes Mellitus, leucocyte count, and atrial fibrillation. While demographic data on
dysphagia variables, congestive heart failure, infarct location and chest X-ray images
between SAI and non-SAI groups had significant differences. The mean age is 60, 37 pm
10.51 years and 64.8% are male. In general, gender differences are associated with the
incidence of stroke. The relationship between age and stroke affects more men. The incidence
of stroke at the age of geq55 years ranged from 420 to 650 per 100,000 population, where
most were men. Research data in Indonesia states, the incidence of stroke increases with age..

In the age group 45-54 years the stroke prevalence was 16.7%, in the 55-64 year age
group by 33.0%, in the 65-74 year age group by 46.1% and in the> 75 year age group by 67% .
Male sex is still more than females (7.1% males and 6.8% females). 9 Mortality and disability
between men and women who experienced acute ischemic stoke had no significant difference.
10; 11 In contrast to studies conducted by Petrea RE et al (2009) which concluded that women
had stroke outcomes that were worse than men, the presence of disabilities before stroke and
sociodemographic factors further exacerbated stroke outcomes. This statement is supported by
other studies which say that women experience longer periods of treatment, disabilities and
handicaps that are heavier than men. Other studies say that women's daily life activities are more
dependent on others on post-stroke observation for 12 months than men.

Conclusion

Mortality and disability between men and women who experience acute ischemic stoke has
no significant difference. Lyocytosis is an inflammatory response indicator. leukocytosis at the
start of hospital admission is associated with severe stroke in patients with acute ischemic stroke
and persistent lecocytosis indicates poor markers of output. Diabetes mellitus is a risk factor for
infection in acute ischemic stroke. In this study there was no correlation between diabetes mellitus
status and the occurrence of SAI. Dysphagia is an important factor in the process of developing
SAI. In the study, the results were very significant. Pneumonia is reported in 7-22% of stroke
patients, where dysphagia and aspiration are the most important factors. Non lacunar infarction in
basal ganglia is a major risk factor for SAI. In this study it was found that there was a significant
relationship between the location of the infarct and the occurrence of SAI. Pneumonia and urinary
 tract infections were the most common infections in patients with acute ischemic stroke. In this
study found 20% of the study subjects had pneumonia, 6.4% had a urinary tract infection. Atrial
fibrillation and congestive heart failure are risk factors and can be a comorbid factor in the
occurrence of SAI. In this study atrial fibrillation was not associated with the occurrence of SAI
but congestive heart failure was significantly associated with the onset of SAI.

D. DISCUSSION
This journal Prognostic Factors for Stroke Associated Infection (SAI) in Acute
Ischemic Stroke Patients very helpful in health education institutions and the health world
itself. Given the rarity of research that leads to discussion of the Prognostic factor that cause Stroke
Associated Infection (SAI). As for us as a reviewer will try to outline the advantages and
disadvantages of this journal article:

1. Advantages
The advantages of this journal are to explain in detail about Prognostic factor that cause
Stroke Associated Infection (SAI). The journal also explain each factor completely and give the
comparison with other research and make us sure about the result.

2. Disadvantges
The weakness of this Journal is retrospective and the sample is only a few. In the future
further research is needed in the form of a prospective cohort with a larger sample.

E. CONCLUSION AND SUGGESTION

1. Conclusion
From the above review, it can be concluded that:
a. There are some Prognostic factor that cause SAI
b That factors are ; Gender, Dysphagia, Thorax, and congestive heart failure

2. Suggestion
Review provides suggestions addressed to this journal, as for the inputs are as follows:
a. Do it with larger sample.
b. It will be better if make with prospective cohort research
 REFRENCE

Baril, Francine. "Multiple sclerosis, vision problems and visual impairment

interventions." (2011).