Predictive Factors of Swallowing Disorders and Bronchopneumonia in Acute Ischemic Stroke

J Stroke Cerebrovasc Dis. 2019 Aug;28(8):2148-2154. doi: 10.1016/j.jstrokecerebrovasdis.2019.04.025. Epub 2019 May 22.


Background: In stroke patients, early complications such as swallowing disorders (SD) and bronchopneumonia (BP) are frequent and may worsen outcome. The aim of this study was to evaluate the prevalence of SD in acute ischemic stroke (AIS) and the risk of BP, as well as to identify factors associated with these conditions.

Methods: We retrospectively studied all AISs over a 12-month period in a single-center registry. We determined the frequency of SD in the first 7 days and of BP over the entire hospital stay. Associations of SD and BP with patient characteristics, stroke features, dental status, and presence of a feeding tube were analyzed in multivariate analyses.

Results: In the 340 consecutive patients, the overall frequency of SD and BP was 23.8% and 11.5%, respectively. The multivariate analyses showed significant associations of SD with NIHSS scores >4, involvement of the medulla oblongata and wearing a dental prosthesis (area under the receiver-operator curve (AUC) of 76%). BP was significantly associated with NIHSS scores >4, male sex, bilateral cerebral lesions, the presence of SD, and the use of an enteral feeding tube (AUC 84%). In unadjusted analysis, unfavorable 12-month outcome and mortality were increased in the presence of SD.

Conclusion: In AIS, SD and BP are associated with stroke severity and localization and wearing a dental prosthesis increases the risk of SD. Given that patients with SD have an increased risk of poor outcome and mortality, high-risk patients warrant early interventions, including more randomized trials.

Keywords: Swallowing disorders; acute ischemic stroke; bronchopneumonia; dysphagia; predictive factors; speech therapy.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Brain Ischemia / diagnosis
  • Brain Ischemia / epidemiology*
  • Brain Ischemia / physiopathology
  • Bronchopneumonia / diagnosis
  • Bronchopneumonia / epidemiology*
  • Deglutition Disorders / diagnosis
  • Deglutition Disorders / epidemiology*
  • Deglutition Disorders / physiopathology
  • Deglutition*
  • Dental Prosthesis / adverse effects
  • Enteral Nutrition / adverse effects
  • Female
  • Hospitalization
  • Humans
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Prevalence
  • Prognosis
  • Registries
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Severity of Illness Index
  • Sex Factors
  • Stroke / diagnosis
  • Stroke / epidemiology*
  • Stroke / physiopathology
  • Time Factors