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. 2022 May;80(5):462-468.
doi: 10.1590/0004-282X-ANP-2021-0127.

Dysphagia is a strong predictor of death and functional dependence at three months post-stroke

Aline Cristina Pacheco-Castilho  1 , Rubia Poliana Crisóstomo Miranda  2 , Ana Maria Queirós Norberto  3 , Diandra Bosi Favoretto  1 , Brunna Pileggi Rimoli  1 , Luciana Bezerra de Mello Alves  1 , Karina Tavares Weber  1 , Taiza Elaine Grespan Santos  1 , Julio Cesar Moriguti  3 , João Pereira Leite  1 , Roberto Oliveira Dantas  3 , Rosemary Martino  4 , Octávio Marques Pontes-Neto  1
Affiliations

Dysphagia is a strong predictor of death and functional dependence at three months post-stroke

Aline Cristina Pacheco-Castilho et al. Arq Neuropsiquiatr. 2022 May.

Abstract
in English, Portuguese

Background: Few Brazilian studies investigated risk factors for dysphagia and associated complications in a large cohort.

Objective: To investigate frequency, predictors, and associated outcomes of dysphagia in patients up to three months post-stroke.

Methods: Prospective cohort study of consecutively admitted patients in a specialized center for acute stroke. Patients with a transient ischemic attack, subarachnoid hemorrhage, cerebral venous thrombosis, hemorrhagic stroke with secondary cause, non-acute stroke, or those who did not consent to participate were excluded. Swallowing was evaluated by speech language pathologists using Volume-Viscosity Swallow Test. General function at three months post-stroke was assessed using the following instruments: Modified Rankin scale, Barthel Index and Functional Independence Measure.

Results: A total of 831 patients were admitted and 305 patients were included according to the inclusion and exclusion criteria. The mean age of patients was 63.6±13.3 years, mean time from stroke to swallowing assessment was 4.2±4.1 days, and 45.2% of the patients had dysphagia. Age (OR=1.02; 95%CI 1.00-1.04; p=0.017), known medical history of obstructive sleep apnea (OR=5.13; 95%CI 1.74-15.15; p=0.003), and stroke severity at hospital admission (OR=1.10; 95%CI 1.06-1.15; p<0.001) were independently associated with dysphagia. Dysphagia (OR=3.78; 95%CI 2.16-6.61; p<0.001) and stroke severity (OR=1.05; 95%CI 1.00-1.09; p=0.024) were independently associated with death or functional dependence at three months.

Conclusions: Dysphagia was present in almost half of stroke patients. Age, obstructive sleep apnea, and stroke severity were predictors of dysphagia, which was independently associated with death or functional dependence at three months.

Antecedentes:: Poucos estudos brasileiros investigaram fatores de risco para disfagia e suas complicações associadas em uma grande coorte.

Objetivo:: Investigar frequência, preditores e desfechos associados da disfagia em pacientes até três meses após acidente vascular cerebral (AVC).

Métodos:: Selecionamos pacientes admitidos consecutivamente em um centro especializado em AVC agudo. Excluímos pacientes com ataque isquêmico transitório, hemorragia subaracnóidea, trombose venosa cerebral, AVC hemorrágico de causa secundária, AVC não agudo ou aqueles que não consentiram em participar. A deglutição foi avaliada por fonoaudiólogos, por meio do teste de deglutição de volume-viscosidade. A função geral foi avaliada usando-se escala de Rankin modificada, índice de Barthel e medida de independência funcional.

Resultados:: Foram admitidos 831 pacientes e incluídos 305. A idade média foi 63,6±13,3 anos, o tempo médio da avaliação foi 4,2±4,1 dias e 45,2% apresentavam disfagia. Idade (razão de chances [OR] 1,02; intervalo de confiança [IC95%] 1,00-1,04; p=0,017), história médica conhecida de apneia obstrutiva do sono (OR=5,13; IC95% 1,74-15,15; p=0,003) e gravidade do AVC na admissão hospitalar (OR=1,10; IC95% 1,06-1,15; p<0,001) foram independentemente associados à disfagia. Disfagia (OR=3,78; IC95% 2,16-6,61; p<0,001) e gravidade do AVC (OR=1,05; IC95% 1,00-1,09; p=0,024) foram independentemente associadas com morte ou dependência funcional em três meses.

Conclusões:: A disfagia esteve presente em quase metade dos pacientes com AVC. Idade, apneia obstrutiva do sono e gravidade do AVC foram preditores de disfagia, que esteve independentemente associada com morte ou dependência funcional em três meses.

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Conflict of interest statement

Conflict of interest: There is no conflict of interest to declare.

Figures

Figure 1.
Figure 1.. Flowchart of the study.
Figure 2.
Figure 2.. Modified Rankin Scale score (0 to 6; 0=no symptoms, 6=dead) at three months post-stroke in individuals with and without dysphagia diagnosed in the acute phase.
See this image and copyright information in PMC

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