Objectives

Post-stroke dysphagia is associated with aspiration pneumonia, but strategies intended to mitigate this complication, such as oral intake modifications, may unintentionally lead to dehydration-related complications such as urinary tract infections (UTIs) and constipation. This study aimed to determine the rates of aspiration pneumonia, dehydration, UTI and constipation in a large cohort of acute stroke patients and the independent predictors of each complication.

Materials and methods

Data were extracted retrospectively for 31,953 acute stroke patients admitted to six hospitals in Adelaide, South Australia over a 20-year period. Tests of difference compared rates of complications between patients with and without dysphagia. Multiple logistic regression modelling explored variables that significantly predicted each complication.

Results

In this consecutive cohort of acute stroke patients, with a mean (SD) age of 73.8 (13.8) years and 70.2% presenting with ischaemic stroke, rates of complications were: aspiration pneumonia (6.5%); dehydration (6.7%); UTI (10.1%); and constipation (4.4%). Each complication was significantly more prevalent for patients with dysphagia compared to those without. Controlling for demographic and other clinical variables, the presence of dysphagia independently predicted aspiration pneumonia (OR=2.61, 95% CI 2.21-3.07; p<.001), dehydration (OR=2.05, 95% CI 1.76-2.38; p<.001), UTI (OR=1.34, 95% CI 1.16-1.56; p<.001), and constipation (OR=1.30, 95% CI 1.07-1.59; p=.009). Additional predictive factors were increased age and prolonged hospitalisation.

Conclusions

Aspiration pneumonia, dehydration, UTI, and constipation are common acute sequelae of stroke and independently associated with dysphagia. Future dysphagia intervention initiatives may utilise these reported complication rates to evaluate their impact on all four adverse health complications.

中文翻译：

---

吞咽困难相关的急性卒中并发症：一项回顾性观察队列研究

目标

中风后吞咽困难与吸入性肺炎有关，但旨在减轻这种并发症的策略（例如调整经口摄入）可能会无意中导致与脱水相关的并发症，例如尿路感染 (UTI) 和便秘。本研究旨在确定大量急性中风患者的吸入性肺炎、脱水、尿路感染和便秘的发生率以及每种并发症的独立预测因子。

材料和方法

回顾性提取了 20 年期间入住南澳大利亚阿德莱德六家医院的 31,953 名急性中风患者的数据。差异检验比较了有和没有吞咽困难患者的并发症发生率。多元逻辑回归模型探索了显着预测每种并发症的变量。

结果

在这个连续的急性卒中患者队列中，平均 (SD) 年龄为 73.8 (13.8) 岁，70.2% 出现缺血性卒中，并发症发生率为：吸入性肺炎 (6.5%)；脱水（6.7%）；尿路感染 (10.1%)；和便秘 (4.4%)。与没有吞咽困难的患者相比，每种并发症在吞咽困难患者中的发生率明显更高。控制人口统计学和其他临床变量后，吞咽困难的存在可独立预测吸入性肺炎 (OR=2.61, 95% CI 2.21-3.07; p<.001)、脱水 (OR=2.05, 95% CI 1.76-2.38; p<. 001）、尿路感染（OR=1.34，95% CI 1.16-1.56；p<.001）和便秘（OR=1.30，95% CI 1.07-1.59；p=.009）。其他预测因素是年龄增加和住院时间延长。

结论

吸入性肺炎、脱水、尿路感染和便秘是中风常见的急性后遗症，与吞咽困难独立相关。未来的吞咽困难干预措施可能会利用这些报告的并发症发生率来评估它们对所有四种不良健康并发症的影响。