Analysis of Risk Factors Associated With Aspiration in Patients With Poststroke Dysphagia: A Real‐World Study

BACKGROUND: Aspiration is the most severe complication of dysphagia in patients with poststroke dysphagia (PSD). However, the risk factors associated with aspiration remain inadequately understood. OBJECTIVE: To determine the associated risk factors for aspiration in patients with PSD. METHODS: A total of 321 dysphagia patients with first-ever stroke were retrospectively enrolled. We differentiated patients with aspiration from those without aspiration via swallowing function screening, clinical swallowing function examinations, and videofluoroscopic swallowing studies. We conducted a comparative analysis of the basic demographic data, disease-related information, and clinical characteristics between the two groups via multivariate logistic regression. RESULTS: Multivariate logistic regression analysis revealed that age ≥ 65 years (OR = 3.596, 95% CI: 1.251-10.335), history of pneumonia (OR = 3.617, 95% CI: 1.174-11.148), severe dysarthria (OR = 7.331, 95% CI: 1.314-40.889), number of chronic diseases > 2 (OR = 4.814, 95% CI: 1.61-14.397), bilateral brain injury (OR = 6.673, 95% CI: 1.926-23.115), a lesion location in the brainstem (OR = 4.581, 95% CI: 1.05-19.987), and a higher water swallowing test score (OR = 1.806, 95% CI: 1.113-2.93) were risk factors for aspiration. Conversely, a high Montreal Cognitive Assessment (MoCA) score (OR = 0.919, 95% CI: 0.849-0.995) and a high cut-off value of the repetitive saliva swallowing test (RSST) (OR = 0.149, 95% CI: 0.067-0.332) were identified as protective factors. DISCUSSION: Timely diagnosis and intervention for aspiration should prioritise patient populations aged 65 years and older, individuals with a history of pneumonia, those exhibiting severe dysarthria, patients with multiple chronic conditions, individuals with bilateral brain injuries, patients with lesions situated in the brainstem, and those exhibiting higher WST scores. TRIAL REGISTRATION: This study was registered with the Chinese Clinical Trial Registry (registration number: ChiCTR2500097142).