Risk factors and predictive model of aspiration pneumonia in stroke patients with dysphagia based on quantitative analysis of videofluoroscopic swallowing study
10.3969/j.issn.1001-1242.2025.03.005
- VernacularTitle:基于吞咽造影定量评估的脑卒中后吞咽障碍并发吸入性肺炎危险因素分析与预测模型构建
- Author:
Weihong XIAO
1
;
Nana LI
1
;
Haipeng JIN
1
Author Information
1. 北京中医药大学厦门医院康复科,福建省厦门市,361009
- Publication Type:Journal Article
- Keywords:
videofluoroscopy swallowing study;
post-stroke dysphagia;
aspiration pneumonia;
prediction model
- From:
Chinese Journal of Rehabilitation Medicine
2025;40(3):349-355
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To analyze the risk factors for aspiration pneumonia m patients with post-stroke dysphagia based on quantitative analysis of videofluoroscopic swallowing study(VFSS),and to construct a prediction model and validate it in order to standardize the management of high-risk patients with post-stroke dysphagia complicating aspiration pneumonia.Method:A total of 556 patients with post-stroke dysphagia admitted to Xiamen Hospital of Beijing University of Traditional Chinese Medicine from July 2021 to June 2023 were selected for the study and divided into a modeling group(n=436)and an external validation group(n=120).The model group was divided into pneumo-nia group(n=113,25.9％)and non-pneumonia group(n=323,74.1％)according to the occurrence of aspiration pneumonia.Clinical data and VFSS results were collected for all participants.Logistic regression identified the risk factors for aspiration pneumonia,and a nomogram predictive model was constructed.Model perfonnance was evaluated using receiver operating characteristic(ROC)curves,the area under the ROC curve(AUC),and the Hosmer-Lemeshow goodness-of-fit test.External validation was conducted to assess the sensitivity,spec-ificity and consistency of the model.Result:Logistic regression analysis showed that advanced age,poor oral hygiene,tracheotomy,Penetration-As-piration Scale(PAS)grade≥5,pharyngeal residue and prolonged pharyngeal transport time were risk factors for aspiration pneumonia,and active cough and eating instruction were protective factors(P＜0.05 for both).The predictive risk index(C-index)of the nomogram prediction model was 0.957,AUC=0.957,sensitivity was 93.8％,specificity was 86.4％,and the Hosmer-Lemeshow goodness of fit test showed P=0.6.Conclusion:The predictive model can be used to predict the occurrence of aspiration pneumonia in stroke pa-tients with dysphagia.Its use in clinical practice allows for the development of targeted and individualized inter-ventions according to patient risk levels,thereby improving the quality of nursing.
