ORIGINAL RESEARCH article
Front. Neurol.
Sec. Neurocritical and Neurohospitalist Care
Volume 16 - 2025 | doi: 10.3389/fneur.2025.1556541
Innovative Nomogram for Predictive Risk Stratification of Aspiration Pneumonia in Post-Stroke Dysphagia Patients
Provisionally accepted
- 1Jinshan Hospital, Fudan University, Shanghai, China
- 2Zhongshan Hospital, Fudan University, Shanghai, Shanghai Municipality, China
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Background: Post-stroke dysphagia (PSD) affects up to 76% of stroke patients and increases aspiration pneumonia (AP) risk, leading to higher mortality among older survivors. Current risk assessment tools for AP in PSD patients lack precision.Methods: We conducted a retrospective study of 7,134 stroke patients admitted to Jinshan Hospital from 2019 to 2023. We used multivariable logistic regression to identify AP predictors and constructed a nomogram model using these predictors. Model performance was evaluated using bootstrap resampling, calibration, and decision curve analysis. Internal validation was conducted on 30% of cases, and external validation was performed on 500 PSD patients from community health centers.Results: Among 2,663 PSD patients, 578 (21.7%) developed AP. Independent predictors included age, stroke severity, hyperlipidemia, hyperhomocysteinemia, heart failure, CRP, WBC, neutrophil ratio, Hb, FBG, prealbumin, BNP, and serum sodium. The nomogram model showed excellent discrimination (C-index: 0.885) and good agreement between predicted and observed AP probabilities. It provided net benefit across various threshold probabilities.Conclusion: Our study developed the first dedicated nomogram for AP risk prediction in PSD patients, incorporating novel predictor combinations and demonstrating robust validation across multi-center cohorts. This fills an important clinical need under community conditions by enabling early identification of high-risk PSD patients using routinely available clinical variables.
Keywords: Post-stroke dysphagia, aspiration pneumonia, risk prediction, Nomogram model, stroke outcomes
Received: 25 Feb 2025; Accepted: 12 May 2025.
Copyright: © 2025 Wang, Wang, Shen, Liao, He and Pan. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Daikun He, Jinshan Hospital, Fudan University, Shanghai, China
Zhigang Pan, Zhongshan Hospital, Fudan University, Shanghai, 200032, Shanghai Municipality, China
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