Innovative nomogram for predictive risk stratification of aspiration pneumonia in post-stroke dysphagia patients
BackgroundPost-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.MethodsWe conducted a retrospective study of 7,134 stroke pa...
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Frontiers Media S.A.
2025-06-01
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2025.1556541/full |
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| author | Junming Wang Junming Wang Junming Wang Junming Wang Pengfei Wang Pengfei Wang Pengfei Wang Zhengyao Shen Kehan Liao Kehan Liao Kehan Liao Daikun He Daikun He Daikun He Daikun He Daikun He Zhigang Pan |
| author_facet | Junming Wang Junming Wang Junming Wang Junming Wang Pengfei Wang Pengfei Wang Pengfei Wang Zhengyao Shen Kehan Liao Kehan Liao Kehan Liao Daikun He Daikun He Daikun He Daikun He Daikun He Zhigang Pan |
| author_sort | Junming Wang |
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| description | BackgroundPost-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.MethodsWe 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.ResultsAmong 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.ConclusionOur 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. |
| format | Article |
| id | doaj-art-fb4046bbbe874a1c99adc8a7def3e0d1 |
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| issn | 1664-2295 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Neurology |
| spelling | doaj-art-fb4046bbbe874a1c99adc8a7def3e0d12025-08-20T02:01:58ZengFrontiers Media S.A.Frontiers in Neurology1664-22952025-06-011610.3389/fneur.2025.15565411556541Innovative nomogram for predictive risk stratification of aspiration pneumonia in post-stroke dysphagia patientsJunming Wang0Junming Wang1Junming Wang2Junming Wang3Pengfei Wang4Pengfei Wang5Pengfei Wang6Zhengyao Shen7Kehan Liao8Kehan Liao9Kehan Liao10Daikun He11Daikun He12Daikun He13Daikun He14Daikun He15Zhigang Pan16Department of General Practice, Jinshan Hospital, Fudan University, Shanghai, ChinaCenter of Emergency and Critical Care Medicine, Jinshan Hospital, Fudan University, Shanghai, ChinaResearch Center for Chemical Injury, Emergency and Critical Medicine of Fudan University, Shanghai, ChinaKey Laboratory of Chemical Injury, Emergency and Critical Medicine of Shanghai Municipal Health Commission, Shanghai, ChinaCenter of Emergency and Critical Care Medicine, Jinshan Hospital, Fudan University, Shanghai, ChinaResearch Center for Chemical Injury, Emergency and Critical Medicine of Fudan University, Shanghai, ChinaKey Laboratory of Chemical Injury, Emergency and Critical Medicine of Shanghai Municipal Health Commission, Shanghai, ChinaDepartment of General Practice, Jinshan Hospital, Fudan University, Shanghai, ChinaCenter of Emergency and Critical Care Medicine, Jinshan Hospital, Fudan University, Shanghai, ChinaResearch Center for Chemical Injury, Emergency and Critical Medicine of Fudan University, Shanghai, ChinaKey Laboratory of Chemical Injury, Emergency and Critical Medicine of Shanghai Municipal Health Commission, Shanghai, ChinaDepartment of General Practice, Jinshan Hospital, Fudan University, Shanghai, ChinaCenter of Emergency and Critical Care Medicine, Jinshan Hospital, Fudan University, Shanghai, ChinaResearch Center for Chemical Injury, Emergency and Critical Medicine of Fudan University, Shanghai, ChinaKey Laboratory of Chemical Injury, Emergency and Critical Medicine of Shanghai Municipal Health Commission, Shanghai, ChinaDepartment of General Practice, Zhongshan Hospital, Fudan University, Shanghai, ChinaDepartment of General Practice, Zhongshan Hospital, Fudan University, Shanghai, ChinaBackgroundPost-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.MethodsWe 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.ResultsAmong 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.ConclusionOur 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.https://www.frontiersin.org/articles/10.3389/fneur.2025.1556541/fullpost-stroke dysphagiaaspiration pneumoniarisk predictionnomogram modelstroke outcomes |
| spellingShingle | Junming Wang Junming Wang Junming Wang Junming Wang Pengfei Wang Pengfei Wang Pengfei Wang Zhengyao Shen Kehan Liao Kehan Liao Kehan Liao Daikun He Daikun He Daikun He Daikun He Daikun He Zhigang Pan Innovative nomogram for predictive risk stratification of aspiration pneumonia in post-stroke dysphagia patients Frontiers in Neurology post-stroke dysphagia aspiration pneumonia risk prediction nomogram model stroke outcomes |
| title | Innovative nomogram for predictive risk stratification of aspiration pneumonia in post-stroke dysphagia patients |
| title_full | Innovative nomogram for predictive risk stratification of aspiration pneumonia in post-stroke dysphagia patients |
| title_fullStr | Innovative nomogram for predictive risk stratification of aspiration pneumonia in post-stroke dysphagia patients |
| title_full_unstemmed | Innovative nomogram for predictive risk stratification of aspiration pneumonia in post-stroke dysphagia patients |
| title_short | Innovative nomogram for predictive risk stratification of aspiration pneumonia in post-stroke dysphagia patients |
| title_sort | innovative nomogram for predictive risk stratification of aspiration pneumonia in post stroke dysphagia patients |
| topic | post-stroke dysphagia aspiration pneumonia risk prediction nomogram model stroke outcomes |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2025.1556541/full |
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