Hotz Julian Frederic, Kaindl Lisa, Schneider Lisa, Krebs Stefan, Karisik Anel, Mikšová Dominika, Bichler Maximilian, Ritscher Lavinia, Staudacher Moritz, Lagler Heimo, Burgmann Heinz, Lang Wilfried, Ferrari Julia, Knoflach Michael, Sykora Marek
Department of Neurology, St. John's Hospital, Johannes von Gott Platz 1, 1020, Vienna, Austria.
Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria.
Neurol Ther. 2025 Jun 9. doi: 10.1007/s40120-025-00783-1.
Dysphagia and pneumonia are common complications in patients with acute ischemic stroke (AIS), contributing to increased morbidity and mortality. This study evaluated the impact of pneumonia and dysphagia management strategies (including dysphagia screening, speech therapy, and nasogastric tube use) on patients with AIS outcomes.
This nationwide, multicenter study included 181,704 patients with AIS from the Austrian Stroke Unit Registry (2006-2024). The impact of pneumonia and the influence of dysphagia management on favorable functional outcome (modified Rankin Scale ≤ 1) and mortality of patients with AIS were calculated using multivariable Poisson regression models.
Pneumonia occurred in 15.7% of severely and in 6.7% of moderately affected patients with AIS and was associated with increased mortality (RR 1.61, 95% CI 1.50-1.72, p < 0.05) and inversely with favorable functional outcome (RR 0.37, 95% CI 0.31-0.44, p < 0.05). Dysphagia management was significantly (p < 0.05) associated with reduced mortality, especially in moderately to severely affected patients with AIS, but had a limited impact on functional outcome. After implementation of dysphagia screening, a significant (p < 0.05) decrease in pneumonia prevalence was noted.
Among patients with severe acute ischemic stroke, early dysphagia management strategies are associated with reduced mortality, while stroke-associated pneumonia remains a persistent predictor of poor prognosis. These findings underscore the important role of standardized dysphagia management in improving stroke care and patient outcomes.
吞咽困难和肺炎是急性缺血性卒中（AIS）患者常见的并发症，会导致发病率和死亡率增加。本研究评估了肺炎及吞咽困难管理策略（包括吞咽困难筛查、言语治疗和鼻胃管使用）对AIS患者预后的影响。
这项全国性的多中心研究纳入了来自奥地利卒中单元登记处（2006 - 2024年）的181704例AIS患者。使用多变量泊松回归模型计算肺炎的影响以及吞咽困难管理对AIS患者良好功能预后（改良Rankin量表≤1）和死亡率的影响。
15.7%的重度和6.7%的中度AIS患者发生了肺炎，肺炎与死亡率增加相关（风险比[RR]1.61，95%置信区间[CI]1.50 - 1.72，p < 0.05），与良好功能预后呈负相关（RR 0.37，95% CI 0.31 - 0.44，p < 0.05）。吞咽困难管理与死亡率降低显著相关（p < 0.05），尤其是在中度至重度AIS患者中，但对功能预后的影响有限。实施吞咽困难筛查后，肺炎患病率显著下降（p < 0.05）。
在重度急性缺血性卒中患者中，早期吞咽困难管理策略与死亡率降低相关，而卒中相关性肺炎仍然是预后不良的持续预测因素。这些发现强调了标准化吞咽困难管理在改善卒中护理和患者预后方面的重要作用。
