The Mortality and the Risk of Aspiration Pneumonia Related with Dysphagia in Stroke Patients

Background: Dysphagia may result in poor outcomes in stroke patients due to aspiration pneumonia and malnutrition. Goal: The aim of the study was to investigate aspiration pneumonia and the mortality rate in stroke patients with dysphagia in Taiwan. Methods: We selected 1220 stroke patients, divided them into dysphagia and nondysphagia groups, and matched them according to age; covariates and comediations from 2000 to 2005 were identified from the NHIRD 2000 database. The date of the diagnosed stroke for each patient was defined as the index date. All patients were tracked for 5 years following their index visit to evaluate mortality and the risk of aspiration pneumonia. We estimated the adjusted hazard ratio using Cox proportional hazard regression. Results: Within 1 year, the dysphagia group was 4.69 times more likely to develop aspiration pneumonia than the nondysphagia group (adjusted hazard ratio [aHR], 4.69; 95% confidence interval [CI] 2.83-7.77; P < .001). The highest significant risk of aspiration pneumonia was in the cerebral hemorrhage patients within 3 years of the index visit (aHR, 5.04; 95% CI 1.45-17.49; P = .011). The 5-year mortality rate in the dysphagia group was significantly higher than that in the nondysphagia group (aHR, 1.84; 95% CI 1.57-2.16; P < .001). Conclusion: Dysphagia is a critical factor in aspiration pneumonia and mortality in stroke patients. Early detection and intervention of dysphagia in stroke patients may reduce the possibility of aspiration pneumonia.