Front. Nutr.
Sec. Nutrition, Psychology and Brain Health
doi: 10.3389/fnut.2022.970253

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

Peiliang Zhang1,  Wenbo Zhang1, Wujie Shi1,  Weng Jianbin1, Zhongyuan Zhang1, Chao Lin1, Ning Wang1, Zhipeng Shen1* and  Zhilin Chen2*
  • 1Department of Neurosurgery, The Children’s Hospital of Zhejiang University School of Medicine, China
  • 2Department of Neurology, Shanghai Fourth People's Hospital, China
Provisionally accepted:
The final, formatted version of the article will be published soon.

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 one week after admission (Functional Oral Intake Scale ≤ 4). Swallowing function and stroke-associated pneumonia (SAP) at one 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 one 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: Swallowing function, dysphagia, Acute ischemic stroke, Nasogastric tube, Stroke associated pneumonia

Received: 15 Jun 2022; Accepted: 02 Sep 2022.

Copyright: © 2022 Zhang, Zhang, Shi, Jianbin, Zhang, Lin, Wang, Shen and Chen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence:
Prof. Zhipeng Shen, Department of Neurosurgery, The Children’s Hospital of Zhejiang University School of Medicine, Hangzhou, China
Dr. Zhilin Chen, Department of Neurology, Shanghai Fourth People's Hospital, Shanghai, China