Swallowing function after acute ischemic stroke: Development and validation of a novel clinical prognostic model

Peiliang Zhang; Wenbo Zhang; Wujie Shi; Jianbin Weng; Zhongyuan Zhang; Chao Lin; Ning Wang; Zhipeng Shen; Zhi-Lin Chen

doi:10.3389/fnut.2022.970253

Swallowing function after acute ischemic stroke: Development and validation of a novel clinical prognostic model

Front Nutr. 2022 Oct 5:9:970253. doi: 10.3389/fnut.2022.970253. eCollection 2022.

Authors

Peiliang Zhang¹, Wenbo Zhang¹, Wujie Shi¹, Jianbin Weng¹, Zhongyuan Zhang¹, Chao Lin¹, Ning Wang¹, Zhipeng Shen¹, Zhi-Lin Chen²

Affiliations

¹ Department of Neurosurgery, The Children's Hospital of Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.
² Department of Neurology, Translational Research Institute of Brain and Brain-Like Intelligence, Shanghai Fourth People's Hospital Affiliated to Tongji University School of Medicine, Shanghai, China.

Abstract

Background: Predicting the duration of dysphagia after acute ischemic stroke (AIS) is important for clinical treatment decisions.

Objective: The purpose of this study is to assess the swallowing function of AIS patients and to develop and validate a prognostic model for the need for nasogastric tube (NGT) in these patients.

Materials and methods: We included 554 AIS patients during 2018-2019 as the development group and had 186 AIS patients as the external validation group. The primary end point of the study was the retention of NGT in patients 1 week after admission (Functional Oral Intake Scale ≤ 4). Swallowing function and stroke-associated pneumonia (SAP) at 1 month post-onset were also the objectives of this study. The volume-viscosity swallow test (V-VST) was used to assess the patient's impaired swallowing function. The Predictive model was built by logistic regression.

Results: Overall, a total of 104 patients required indwelling NGT at 1 week of AIS onset in development group. The final prognostic model includes 5 variables: age (OR: 1.085, 95%CI: 1.049-1.123), neutrophil-to-lymphocyte ratio (NLR) (OR: 1.332, 95%CI: 1.090-1.626), NIHSS (OR: 1.092, 95%CI: 1.025-1.164), history of drinking (OR: 2.532, 95%CI: 1.452-4.417) and stroke location (Subtentorial vs. Supratentorial, OR: 1.954, 95%CI: 1.088-3.509). The prediction model had an AUC of 0.810, while the external validation group was 0.794.

Conclusion: In stroke patients, it is very important to decide early whether to indwell a NGT. The nomogram will support decision making for NGT insertion and help these patients recover from their condition.

Keywords: acute ischemic stroke; dysphagia; nasogastric tube; stroke associated pneumonia; swallowing function.