Abstract
Few Brazilian studies investigated risk factors for dysphagia and associated complications in a large cohort. To investigate frequency, predictors, and associated outcomes of dysphagia in patients up to three months post-stroke. 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. 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. 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.
Highlights
Dysphagia is common in post-stroke individuals[1] and contributes to worse long-term outcomes, including functional dependence[2-5], institutionalization[2,4-7] and increased mortality[2-9]
Some studies with stroke individuals have demonstrated that the presence of dysphagia is associated with age[2,5-8,10], female sex[2,5,6], stroke severity[2,4,5,7,8,11], hemorrhagic stroke[6,8], lesion in the left hemisphere[9], stroke involving total anterior circulation[6], stroke with involvement of the middle cerebral artery[8], brain stem lesion[10], prior stroke[5,9,12], hypertension[2,5], diabetes[10] and atrial fibrillation[2,6,8]
A total of 831 individuals with suspected stroke were admitted to hospital between April 2015 and September 2016
Summary
Dysphagia is common in post-stroke individuals[1] and contributes to worse long-term outcomes, including functional dependence[2-5], institutionalization[2,4-7] and increased mortality[2-9]. Only two Brazilian studies were conducted prospectively with a large sample of stroke individuals to identify the factors associated with dysphagia and the impact of dysphagia on this population[9,14]. These studies have explored few risk factors and did not report blinded assessments of outcomes. 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. Obstructive sleep apnea, and stroke severity were predictors of dysphagia, which was independently associated with death or functional dependence at three months
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