Objective:

To identify independent predictors of stroke-associated pneumonia (SAP) in patients with acute isolated pontine infarction (AIPI) and to investigate the association between SAP and short-term prognosis.

Approach:

• Study Design: Retrospective study including 179 patients with AIPI admitted between March 2021 and March 2024.
• Data Collection: Baseline clinical data, swallowing function, and serum biomarkers were analyzed.
• Statistical Analysis: Multivariate logistic regression was used to determine independent predictors of SAP, and ROC curve analysis assessed predictive performance.

Key Findings:

• SAP occurred in 19 (10.61%) patients.
• Patients with SAP were older and had higher Water Swallow Test (WST) scores, National Institutes of Health Stroke Scale (NIHSS) scores, fibrinogen, C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI), as well as lower serum albumin levels (all p < 0.05).
• WST score (OR = 2.622, 95% CI: 1.378–4.991, p = 0.003), serum albumin level (OR = 0.831, 95% CI: 0.735–0.940, p < 0.001), and SII (OR = 1.004, 95% CI: 1.002–1.006, p < 0.001) were identified as independent predictors of SAP.
• The combined model had an AUC of 0.938, sensitivity of 89.5%, and specificity of 86.9%.
• SAP was independently associated with short-term poor functional outcome [modified Rankin Scale (mRS) score ≥ 3] (OR = 8.082, 95% CI: 2.922–22.355, p < 0.001).

Interpretation:

SAP is independently associated with a significantly increased risk of short-term poor functional outcome. WST score, serum albumin, and SII are independent predictors of SAP in patients with AIPI.

Limitations:

• Retrospective design may introduce bias.
• Single-center study limits generalizability.

Conclusion:

The combination of WST score, serum albumin, and SII provides a simple, cost-effective bedside model for early identification and prevention of post-stroke pneumonia.