To explore the predictive method and value of tracheotomy complicated with pulmonary infection in hemorrhagic stroke.

One hundred and forty-two patients with hemorrhagic stroke undergoing tracheotomy from May 2018 to February 2020 in Critical Care Medicine Department of Bozhou People's Hospital were enrolled as subjects. They were divided into the occurrence group and the non occurrence group according whether pulmonary infection happened or not. The risk factors of pulmonary infection in patients with intracerebral hemorrhage after tracheotomy were analyzed, and the serum albumin (Alb), procalcitonin (PCT) and D-dimer (D-D) levels were compared between the two groups on the next day after tracheotomy. The receiver operating characteristic (ROC) curve was used to analyze the serum Alb, PCT, D-D levels and the value of the combination of the three in predicting pulmonary infection after tracheotomy after intracerebral hemorrhage.

Thirty-three patients (23.24%) in this group were complicated with pulmonary infection, and were included in the occurrence group, while 109 patients in the non-occurrence group. The serum Alb level of patients with hemorrhagic stroke after tracheotomy in the occurrence group was significantly lower than that of the non-occurrence group [(34.28±7.61) g/L vs (48.15±9.27) g/L], and the levels of PCT and D-D were significantly higher than that of the non-occurrence group [(0.25±0.06) ng/mL vs (0.17±0.05) ng/mL; (253.16±41.27) μg/L vs (168.41±35.24) μg/L] (P<0.05). Chronic obstructive pulmonary disease, smoking history, hypoproteinemia, tracheotomy distance and onset time ≥ 5 d, tracheal intubation, ventilator use, broad-spectrum antibiotics, perform craniocerebral surgery, serum ALb<40 g/L, PCT≥0.15 ng/L, D-D≥200 μg/L were independent risk factors of pulmonary infection in patients with hemorrhagic stroke undergoing tracheotomy (P<0.05), and admission GCS score was also an influencing factor (OR=0.551, P=0.023). ROC analysis showed that the optimal cut-off points for serum Alb, PCT, and D-D levels to predict pulmonary infection in patients with hemorrhagic stroke complicated by tracheotomy were 36.29 g/L, 0.23 ng/mL, 228.05 μg/L, respectively. The sensitivity, specificity and area under curve (AUC) of serum ALb, PCT and D-D combination were 69.70%, 97.25% and 0.912 respectively. The specificity and AUC were higher than those of serum ALb, PCT and D-D alone (P<0.05), and the sensitivity was not statistically significant different from those alone (P>0.05).

Patients with intracerebral hemorrhage undergoing tracheotomy have a high risk of pulmonary infection, and chronic obstructive pulmonary disease, smoking history, hypoproteinemia, etc. and serum Alb<40 g/L, PCT≥0.15 ng/L, and D-D≥200 g/L are the influencing factors, and the combination of serum ALb, PCT and D-D levels can be used to predict pulmonary infection.