Clinica Neurologica dell'Università di Genova, Genoa, Italy.
IRCCS per l'Oncologia e la Neurologia, Ospedale Policlinico San Martino, Genoa, Italy.
Neurol Sci. 2019 Aug;40(8):1619-1626. doi: 10.1007/s10072-019-03896-2. Epub 2019 Apr 19.
We performed an evaluation of dysphagia in an unselected series of strokes to identify factors causing persisting dysphagia at 1 month after onset and to formulate a predictive score.
We evaluated the association between dysphagia and clinical aspects (univariate analysis) at the 7th and 30th days after admission. We performed a multivariate logistic regression at the 30th day on the factors that were significant. We computed a simple score for predicting persistent dysphagia.
We recruited 249 patients. At the 7th day, 94 patients were dysphagic (37.75%). Factors associated with dysphagia included TACI (OR 3.85), mRS ≥ 3 (OR 4.45), malnutrition (OR 2.69), and BMI ≥ 20 (OR 0.52). At the 30th day, 217 patients remained in the study, and dysphagia persisted in 75 (36.76%). The factors that were associated with dysphagia were age > 74 years (OR 1.99), TACI (OR 5.82), mRS score ≥ 3 (OR 4.31), malnutrition (OR 3.27), and BMI ≥ 20 (OR 0.45). The multivariate analysis indicated that mRS ≥ 3 (OR 1.80) and BMI ≥ 20 (OR 0.45) remained significantly associated with dysphagia. The best correlation with dysphagia was the sum of mRS and the reciprocal of the BMI multiplied by 100 ((mRS + 1 ∕ BMI) × 100). We named this score PreDyScore that ranged between 3.7 and 10.47. Using < 6 and > 8 as cutoffs, the sensitivity was 67.03%, and the specificity 95.65%.
BMI < 20 and mRS ≥ 3 are easily measurable bedside predictive factors of persistent dysphagia. PreDyScore showed good sensitivity and very good specificity and enables the prediction of persistent dysphagia with great accuracy in any clinical setting.
我们对一系列未经选择的卒中患者进行吞咽障碍评估，以确定发病后 1 个月仍存在吞咽障碍的相关因素，并制定预测评分。
我们在入院后第 7 天和第 30 天分别对吞咽障碍与临床因素（单因素分析）之间的关系进行评估。我们在第 30 天对有统计学意义的因素进行多因素逻辑回归分析。我们为预测持续性吞咽障碍制定了一个简单的评分。
我们共招募了 249 名患者。在第 7 天，94 名患者存在吞咽障碍（37.75%）。与吞咽障碍相关的因素包括：前循环大梗死（TACI）（OR 3.85）、改良 Rankin 量表（mRS）评分≥3（OR 4.45）、营养不良（OR 2.69）和 BMI≥20（OR 0.52）。在第 30 天，217 名患者仍在研究中，其中 75 名（36.76%）存在持续性吞咽障碍。与吞咽障碍相关的因素包括年龄＞74 岁（OR 1.99）、TACI（OR 5.82）、mRS 评分≥3（OR 4.31）、营养不良（OR 3.27）和 BMI≥20（OR 0.45）。多因素分析表明 mRS≥3（OR 1.80）和 BMI≥20（OR 0.45）与吞咽障碍仍显著相关。与吞咽障碍相关性最好的是 mRS 评分和 BMI 倒数的乘积再乘以 100（（mRS+1/BMI）×100）。我们将该评分命名为 PreDyScore，范围为 3.7 至 10.47。使用＜6 和＞8 作为截断值，灵敏度为 67.03%，特异性为 95.65%。
BMI＜20 和 mRS≥3 是容易测量的、与持续性吞咽障碍相关的床边预测因素。PreDyScore 具有良好的灵敏度和非常好的特异性，能够在任何临床环境下准确预测持续性吞咽障碍。
