严重吞咽困难预测卒中后发热。

Severe Dysphagia Predicts Poststroke Fever.

机构信息

Department of Neurology, University of Ulm, Germany (S.S., M.G., R.K., H.N.).

Department of Neurology, University Hospital Bonn, Germany (S.S.).

出版信息

Stroke. 2021 Jul;52(7):2284-2291. doi: 10.1161/STROKEAHA.120.033396. Epub 2021 Apr 29.

DOI:10.1161/STROKEAHA.120.033396

PMID:33910366

Abstract

BACKGROUND AND PURPOSE

Fever is a common observation after ischemic or hemorrhagic stroke and is associated with a worse clinical outcome. Infections, stroke severity, preexisting medical conditions, insertion of catheters, and dysphagia have been implicated in causing poststroke fever. Given that dysphagia has not been evaluated in detail yet, the aim of this study was to investigate if the severity of dysphagia assessed by a detailed swallowing assessment predicts poststroke fever.

METHODS

In this retrospective monocentric cohort study, all patients admitted for ischemic or hemorrhagic stroke within 12 months were included. Patients underwent a detailed standardized swallowing assessment including a clinical exam by a speech therapist and fiberoptic endoscopic evaluation in a subset of patients. Patients who developed fever within 5 days were compared with patients without fever regarding swallowing parameters and other clinical characteristics relevant for the prediction of poststroke fever.

RESULTS

Nine hundred twenty-three patients with acute ischemic or hemorrhagic stroke were included. One hundred twenty-seven (13.8%) patients developed fever. In multivariable analyses, fever was independently predicted by moderate-to-severe dysphagia in clinical assessments (odds ratio [95% CI], 3.05 [1.65–5.66]) and also by dysphagia with proven risk of aspiration as a combined end point of clinical and instrumental assessments (1.79 [1.07–3.00]). Other independent predictors were stroke severity (odds ratio, 1.06 per point on the National Institutes of Health Stroke Scale score [1.01–1.11]) and the presence of an urinary catheter (odds ratio, 2.03 [1.13–3.65]).

CONCLUSIONS

Severe dysphagia evaluated by a detailed clinical assessment complemented by instrumental testing predicts the development of poststroke fever. Early identification of patients with severe dysphagia after stroke followed by consequent monitoring and treatment might be effective in reducing poststroke fever.

摘要

背景与目的

发热是缺血性或出血性卒中后常见的观察结果，与更差的临床结局相关。感染、卒中严重程度、既往内科疾病、导管插入和吞咽困难与卒中后发热有关。鉴于吞咽困难尚未得到详细评估，本研究旨在探讨详细吞咽评估评估的吞咽困难严重程度是否可预测卒中后发热。

方法

本回顾性单中心队列研究纳入了 12 个月内因缺血性或出血性卒中入院的所有患者。患者接受详细的标准化吞咽评估，包括语言治疗师的临床检查和一部分患者的纤维内镜评估。在 5 天内发生发热的患者与无发热患者相比，评估了吞咽参数和其他与卒中后发热预测相关的临床特征。

结果

共纳入 923 例急性缺血性或出血性卒中患者。127 例（13.8%）患者出现发热。多变量分析显示，中度至重度吞咽困难在临床评估中（优势比[95%CI]，3.05[1.65–5.66]）和在联合临床和仪器评估的证实有吸入风险的吞咽困难中（1.79[1.07–3.00]）均与发热独立相关。其他独立预测因素包括卒中严重程度（优势比，NIHSS 评分每增加 1 分[1.01–1.11]）和留置导尿管（优势比，2.03[1.13–3.65]）。