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Observational Study
. 2018 Dec;97(52):e13968.
doi: 10.1097/MD.0000000000013968.

Different clinical predictors of aspiration pneumonia in dysphagic stroke patients related to stroke lesion: A STROBE-complaint retrospective study

Affiliations
Observational Study

Different clinical predictors of aspiration pneumonia in dysphagic stroke patients related to stroke lesion: A STROBE-complaint retrospective study

Kwang Jae Yu et al. Medicine (Baltimore). 2018 Dec.

Abstract

Although stroke is one of the most common causes of dysphagia, no studies have investigated the radionuclide salivagram as a predictor of aspiration pneumonia in patients with stroke. In addition, few researches on the risk factors of aspiration pneumonia in patients with subacute and chronic stroke undergoing rehabilitation in the rehabilitation unit have been rarely conducted. In this study, therefore, we investigated whether a radionuclide salivagram could predict aspiration pneumonia, and tried to find other clinical factors that may be helpful in predicting aspiration pneumonia in stroke patients undergoing rehabilitation in the rehabilitation department.From March 2013 and January 2018, a retrospective review of the medical records of 1182 subacute and chronic stroke patients who were admitted to rehabilitation department (South Korea) was carried out. We included 117 stroke patients with swallowing difficulties who were admitted to our rehabilitation department and satisfied our criteria retrospectively. Stroke lesion, the degree of paralysis, sex, age, onset duration, feeding methods, the Mini-Mental State Examination (MMSE), the Global Deterioration Scale (GDS), the presence of aspiration in VFSS or salivagram, the penetration-aspiration scale (PAS), and the total score of the Modified Barthel Index (MBI) were investigated by reviewing medical records.To evaluate the predictor of aspiration pneumonia for patients with stroke, multivariate logistic regression analysis with forward stepwise was performed. In the results of this study, only MMSE was significant as a clinical predictor, but not aspiration in VFSS or salivagram in multivariate analysis of supratentorial stroke patients (OR, 0.895) (95% CI, 0.830-964). In multivariate analysis of infratentorial stroke patients, combined results of salivagram and VFSS (aspiration in a salivagram or VFSS) (OR, 0.956) (95% CI, 0.919-995), and total MBI scores were significant as clinical predictors (OR, 24.882) (95% CI, 1.298-477.143).In conclusion, MMSE can be a clinical predictor of the occurrence of aspiration pneumonia in patients with supratentorial stroke. In contrast, total MBI score and combined results of a salivagram and VFSS can be clinical predictors of the occurrence of aspiration pneumonia in patients with infratentorial stroke.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Flow chart of inclusion and exclusion criteria of the study sample. VFSS = videofluoroscopic swallowing study. IPD = idiopathic parkinson's disease, MND = motor neuron disease.
Figure 2
Figure 2
(A) ROC curve of MMSE score for developing aspiration pneumonia in supratentorial stroke patients with dysphagia. The optimal cut-off value (dots on the curves) for MMSE score, which was obtained from the maximal Youden's index, was 18 or less for development of aspiration pneumonia (AUC, 0.707; 95% confidential interval, 0.600–0.800; P = .0023; sensitivity 93.75%, specificity 47.89%). (B) ROC curve of total modified Bathel index (MBI) score for developing aspiration pneumonia in infratentorial stroke patients with dysphagia. The optimal cut-off value (dots on the curves) for total MBI score, which was obtained from the maximal Youden's index, was 52 or less for development of aspiration pneumonia (AUC, 0.731; 95% confidential interval, 0.531–0.880; P = .0243; sensitivity 76.92%, specificity 73.33%). AUC = area under the ROC curve, MBI = modified Barthel index, MMSE = Mini-Mental State Examination, ROC = receiver operating characteristic.

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