Innovative nomogram for predictive risk stratification of aspiration pneumonia in post-stroke dysphagia patients

Junming Wang; Pengfei Wang; Zhengyao Shen; Kehan Liao; Daikun He; Zhigang Pan

doi:10.3389/fneur.2025.1556541

Innovative nomogram for predictive risk stratification of aspiration pneumonia in post-stroke dysphagia patients

Front Neurol. 2025 Jun 3:16:1556541. doi: 10.3389/fneur.2025.1556541. eCollection 2025.

Authors

Junming Wang^{1

2

3

4}, Pengfei Wang^{2

3

4}, Zhengyao Shen¹, Kehan Liao^{2

3

4}, Daikun He^#^{1

2

3

4

5}, Zhigang Pan^#⁵

Affiliations

¹ Department of General Practice, Jinshan Hospital, Fudan University, Shanghai, China.
² Center of Emergency and Critical Care Medicine, Jinshan Hospital, Fudan University, Shanghai, China.
³ Research Center for Chemical Injury, Emergency and Critical Medicine of Fudan University, Shanghai, China.
⁴ Key Laboratory of Chemical Injury, Emergency and Critical Medicine of Shanghai Municipal Health Commission, Shanghai, China.
⁵ Department of General Practice, Zhongshan Hospital, Fudan University, Shanghai, China.

^# Contributed equally.

Abstract

Background: Post-stroke dysphagia (PSD) affects up to 76% of stroke patients and increases aspiration pneumonia (AP) risk, leading to higher mortality among older survivors. Current risk assessment tools for AP in PSD patients lack precision.

Methods: We conducted a retrospective study of 7,134 stroke patients admitted to Jinshan Hospital from 2019 to 2023. We used multivariable logistic regression to identify AP predictors and constructed a nomogram model using these predictors. Model performance was evaluated using bootstrap resampling, calibration, and decision curve analysis. Internal validation was conducted on 30% of cases, and external validation was performed on 500 PSD patients from community health centers.

Results: Among 2,663 PSD patients, 578 (21.7%) developed AP. Independent predictors included age, stroke severity, hyperlipidemia, hyperhomocysteinemia, heart failure, CRP, WBC, neutrophil ratio, Hb, FBG, prealbumin, BNP, and serum sodium. The nomogram model showed excellent discrimination (C-index: 0.885) and good agreement between predicted and observed AP probabilities. It provided net benefit across various threshold probabilities.

Conclusion: Our study developed the first dedicated nomogram for AP risk prediction in PSD patients, incorporating novel predictor combinations and demonstrating robust validation across multi-center cohorts. This fills an important clinical need under community conditions by enabling early identification of high-risk PSD patients using routinely available clinical variables.

Keywords: aspiration pneumonia; nomogram model; post-stroke dysphagia; risk prediction; stroke outcomes.