Comorbidities associated with dysphagia after acute ischemic stroke.

Humans Deglutition Disorders / epidemiology Male Female Aged Ischemic Stroke / epidemiology Comorbidity Middle Aged Aged, 80 and over Registries Prevalence Cohort Studies Austria / epidemiology

Comorbidities Dysphagia Ischemic stroke Risk factors Swallowing impairment

Journal

BMC neurology

ISSN: 1471-2377

Titre abrégé: BMC Neurol

Pays: England

ID NLM: 100968555

Informations de publication

Date de publication:
28 Sep 2024

Historique:

received: 02 07 2024

accepted: 13 09 2024

medline: 29 9 2024

pubmed: 29 9 2024

entrez: 28 9 2024

Statut: epublish

Résumé

Pre-existing comorbidities increase the likelihood of post-stroke dysphagia. This study investigates comorbidity prevalence in patients with dysphagia after ischemic stroke. The data of patients with acute ischemic stroke from two large representative cohorts (STROKE-CARD trial 2014-2019 and STROKE-CARD registry 2020-2022 - both study center Innsbruck, Austria) were analyzed for the presence of dysphagia at hospital admission (clinical swallowing examination). Comorbidities were assessed using the Charlson Comorbidity Index (CCI). Of 2054 patients with ischemic stroke, 17.2% showed dysphagia at hospital admission. Patients with dysphagia were older (77.8 ± 11.9 vs. 73.6 ± 14.3 years, p < 0.001), had more severe strokes (NIHSS 7(4-12) vs. 2(1-4), p < 0.001) and had higher CCI scores (4.7 ± 2.1 vs. 3.8 ± 2.0, p < 0.001) than those without swallowing impairment. Dysphagia correlated with hypertension (p = 0.034), atrial fibrillation (p < 0.001), diabetes (p = 0.002), non-smoking status (p = 0.014), myocardial infarction (p = 0.002), heart failure (p = 0.002), peripheral arterial disease (p < 0.001), severe chronic liver disease (p = 0.002) and kidney disease (p = 0.010). After adjusting for relevant factors, the associations with dysphagia remained significant for diabetes (p = 0.005), peripheral arterial disease (p = 0.007), kidney disease (p = 0.014), liver disease (p = 0.003) and overall CCI (p < 0.001). Patients with multiple comorbidities have a higher risk of developing post-stroke dysphagia. Therefore, early and thorough screening for swallowing impairment after acute ischemic stroke is crucial especially in those with multiple concomitant diseases. Stroke Card Registry (NCT04582825), Stroke Card Trial (NCT02156778).

Sections du résumé

BACKGROUND BACKGROUND

Pre-existing comorbidities increase the likelihood of post-stroke dysphagia. This study investigates comorbidity prevalence in patients with dysphagia after ischemic stroke.

METHODS METHODS

The data of patients with acute ischemic stroke from two large representative cohorts (STROKE-CARD trial 2014-2019 and STROKE-CARD registry 2020-2022 - both study center Innsbruck, Austria) were analyzed for the presence of dysphagia at hospital admission (clinical swallowing examination). Comorbidities were assessed using the Charlson Comorbidity Index (CCI).

RESULTS RESULTS

Of 2054 patients with ischemic stroke, 17.2% showed dysphagia at hospital admission. Patients with dysphagia were older (77.8 ± 11.9 vs. 73.6 ± 14.3 years, p < 0.001), had more severe strokes (NIHSS 7(4-12) vs. 2(1-4), p < 0.001) and had higher CCI scores (4.7 ± 2.1 vs. 3.8 ± 2.0, p < 0.001) than those without swallowing impairment. Dysphagia correlated with hypertension (p = 0.034), atrial fibrillation (p < 0.001), diabetes (p = 0.002), non-smoking status (p = 0.014), myocardial infarction (p = 0.002), heart failure (p = 0.002), peripheral arterial disease (p < 0.001), severe chronic liver disease (p = 0.002) and kidney disease (p = 0.010). After adjusting for relevant factors, the associations with dysphagia remained significant for diabetes (p = 0.005), peripheral arterial disease (p = 0.007), kidney disease (p = 0.014), liver disease (p = 0.003) and overall CCI (p < 0.001).

CONCLUSIONS CONCLUSIONS

Patients with multiple comorbidities have a higher risk of developing post-stroke dysphagia. Therefore, early and thorough screening for swallowing impairment after acute ischemic stroke is crucial especially in those with multiple concomitant diseases.

TRIAL REGISTRATION BACKGROUND

Stroke Card Registry (NCT04582825), Stroke Card Trial (NCT02156778).

Identifiants

DOI: 10.1186/s12883-024-03863-1 PMID: 39342159

pubmed: 39342159

doi: 10.1186/s12883-024-03863-1

pii: 10.1186/s12883-024-03863-1

doi:

Banques de données

ClinicalTrials.gov

['NCT04582825', 'NCT02156778']

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

Pagination

358

Investigateurs

Markus Anliker (M)

Gregor Broessner (G)

Julia Ferrari (J)

Martin Furtner (M)

Andrea Griesmacher (A)

Ton Hanel (T)

Viktoria Hasibeder (V)

Katharina Kaltseis (K)

Gerhard Klingenschmid (G)

Theresa Köhler (T)

Stefan Krebs (S)

Florian Krismer (F)

Clemens Lang (C)

Christoph Mueller (C)

Wolfgang Nachbauer (W)

Anna Neuner (A)

Anja Perfler (A)

Thomas Porpaczy (T)

Gerhard Rumpold (G)

Christoph Schmidauer (C)

Theresa Schneider (T)

Lisa Seekircher (L)

Uwe Siebert (U)

Christine Span (C)

Martin Sojer (M)

Lydia Thiemann (L)

Lena Tschiderer (L)

Marlies Wichtl (M)

Karin Willeit (K)

Informations de copyright

Références

Collaborators GS. Global, regional, and national burden of stroke and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol. 2021;20(10):795–820. https://doi.org/10.1016/S1474-4422(21)00252-0 .

doi: 10.1016/S1474-4422(21)00252-0

Nikbakht H-A, Shojaie L, Niknejad N, et al. Mortality rate of acute stroke in iran: a systematic review and meta-analysis. Caspian J Neurol Sci. 2022;8(4):252–67. https://doi.org/10.32598/cjns.4.31.338.1 .

doi: 10.32598/cjns.4.31.338.1

Cohen DL, Roffe C, Beavan J, et al. Post-stroke dysphagia: A review and design considerations for future trials. Int J Stroke. 2016;11(4):399–411. https://doi.org/10.1177/1747493016639057 .

doi: 10.1177/1747493016639057 pubmed: 27006423

Yang S, Choo YJ, Chang MC. The preventive effect of dysphagia screening on pneumonia in acute stroke patients: A systematic review and meta-analysis. Healthcare (Basel) 2021;9(12), https://doi.org/10.3390/healthcare9121764 .

Jones CA, Colletti CM, Ding MC. Post-stroke dysphagia: recent insights and unanswered questions. Curr Neurol Neurosci Rep. 2020;20(12):61. https://doi.org/10.1007/s11910-020-01081-z .

doi: 10.1007/s11910-020-01081-z pubmed: 33136216 pmcid: 7604228

Yang C, Pan Y. Risk factors of dysphagia in patients with ischemic stroke: A meta-analysis and systematic review. PLoS ONE. 2022;17(6):e0270096. https://doi.org/10.1371/journal.pone.0270096 .

doi: 10.1371/journal.pone.0270096 pubmed: 35709228 pmcid: 9202855

Banda KJ, Chu H, Kang XL, et al. Prevalence of dysphagia and risk of pneumonia and mortality in acute stroke patients: a meta-analysis. BMC Geriatr. 2022;22(1):420. https://doi.org/10.1186/s12877-022-02960-5 .

doi: 10.1186/s12877-022-02960-5 pubmed: 35562660 pmcid: 9103417

Willeit P, Toell T, Boehme C, et al. STROKE-CARD care to prevent cardiovascular events and improve quality of life after acute ischaemic stroke or TIA: A randomised clinical trial. EClinicalMedicine 2020;25(100476), https://doi.org/10.1016/j.eclinm.2020.100476 .

Brott T, Adams HP, Olinger CP, et al. Measurements of acute cerebral infarction: a clinical examination scale. Stroke. 1989;20(7):864–70. https://doi.org/10.1161/01.str.20.7.864 .

doi: 10.1161/01.str.20.7.864 pubmed: 2749846

Quinn TJ, Dawson J, Walters MR, et al. Reliability of the modified Rankin Scale: a systematic review. Stroke. 2009;40(10):3393–5. https://doi.org/10.1161/STROKEAHA.109.557256 .

doi: 10.1161/STROKEAHA.109.557256 pubmed: 19679846

Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–83. https://doi.org/10.1016/0021-9681(87)90171-8 .

doi: 10.1016/0021-9681(87)90171-8 pubmed: 3558716

Jiménez Caballero PE, López Espuela F, Portilla Cuenca JC, et al. Charlson comorbidity index in ischemic stroke and intracerebral hemorrhage as predictor of mortality and functional outcome after 6 months. J Stroke Cerebrovasc Dis. 2013;22(7):e214–8. https://doi.org/10.1016/j.jstrokecerebrovasdis.2012.11.014 .

doi: 10.1016/j.jstrokecerebrovasdis.2012.11.014 pubmed: 23352682

Thygesen K, Alpert JS, Jaffe AS, et al. Fourth Universal Definition of Myocardial Infarction (2018). J Am Coll Cardiol. 2018;72(18):2231–64. https://doi.org/10.1016/j.jacc.2018.08.1038 .

doi: 10.1016/j.jacc.2018.08.1038 pubmed: 30153967

Horn J, Simpson KN, Simpson AN, et al. Incidence of poststroke depression in patients with poststroke dysphagia. Am J Speech Lang Pathol. 2022;31(4):1836–44. https://doi.org/10.1044/2022_AJSLP-21-00346 .

doi: 10.1044/2022_AJSLP-21-00346 pubmed: 35858266 pmcid: 9531926

Hall RE, Porter J, Quan H, et al. Developing an adapted Charlson comorbidity index for ischemic stroke outcome studies. BMC Health Serv Res. 2019;19(1):930. https://doi.org/10.1186/s12913-019-4720-y .

doi: 10.1186/s12913-019-4720-y pubmed: 31796024 pmcid: 6892203

Fandler S, Gattringer T, Eppinger S, et al. Frequency and predictors of dysphagia in patients with recent small subcortical infarcts. Stroke. 2017;48(1):213–5. https://doi.org/10.1161/STROKEAHA.116.015625 .

doi: 10.1161/STROKEAHA.116.015625 pubmed: 27924054

Muhle P, Wirth R, Glahn J, et al. [Age-related changes in swallowing. Physiology and pathophysiology]. Nervenarzt. 2015;86(4):440–51. https://doi.org/10.1007/s00115-014-4183-7 .

doi: 10.1007/s00115-014-4183-7 pubmed: 25833400

Pantoni L. Cerebral small vessel disease: from pathogenesis and clinical characteristics to therapeutic challenges. Lancet Neurol. 2010;9(7):689–701. https://doi.org/10.1016/S1474-4422(10)70104-6 .

doi: 10.1016/S1474-4422(10)70104-6 pubmed: 20610345

Alkagiet S, Papagiannis A, Tziomalos K. Associations between nonalcoholic fatty liver disease and ischemic stroke. World J Hepatol. 2018;10(7):474–8. https://doi.org/10.4254/wjh.v10.i7.474 .

doi: 10.4254/wjh.v10.i7.474 pubmed: 30079133 pmcid: 6068844

Ochoa-Sanchez R, Rose CF. Pathogenesis of Hepatic Encephalopathy in Chronic Liver Disease. J Clin Exp Hepatol. 2018;8(3):262–71. https://doi.org/10.1016/j.jceh.2018.08.001 .

doi: 10.1016/j.jceh.2018.08.001 pubmed: 30302043 pmcid: 6175755

L’Écuyer S, Charbonney E, Carrier FM, et al. Implication of hypotension in the pathogenesis of cognitive impairment and brain injury in chronic liver disease. Neurochem Res. 2023. https://doi.org/10.1007/s11064-022-03854-z .

doi: 10.1007/s11064-022-03854-z pubmed: 36635437

Soleimanpour H. Bilirubin: from a disease predictor to a potential therapeutic in stroke. Int J Aging. 2023;1(1):e1–e1. https://doi.org/10.34172/ija.2023.e1 .

doi: 10.34172/ija.2023.e1

Martino R, Foley N, Bhogal S, et al. Dysphagia after stroke: incidence, diagnosis, and pulmonary complications. Stroke. 2005;36(12):2756–63. https://doi.org/10.1161/01.STR.0000190056.76543.eb .

doi: 10.1161/01.STR.0000190056.76543.eb pubmed: 16269630