Dysphagia and tube feeding after stroke are associated with poorer functional and mortality outcomes

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dc.contributor.authorSouza, Juli Thomaz [UNESP]
dc.contributor.authorRibeiro, Priscila Watson [UNESP]
dc.contributor.authorde Paiva, Sérgio Alberto Rupp [UNESP]
dc.contributor.authorTanni, Suzana Erico [UNESP]
dc.contributor.authorMinicucci, Marcos Ferreira [UNESP]
dc.contributor.authorZornoff, Leonardo Antônio Mamede [UNESP]
dc.contributor.authorPolegato, Bertha Furlan [UNESP]
dc.contributor.authorBazan, Silméia Garcia Zanati [UNESP]
dc.contributor.authorModolo, Gabriel Pinheiro [UNESP]
dc.contributor.authorBazan, Rodrigo [UNESP]
dc.contributor.authorAzevedo, Paula Schmidt [UNESP]
dc.contributor.institutionUniversidade Estadual Paulista (Unesp)
dc.date.accessioned2020-12-12T01:50:45Z
dc.date.available2020-12-12T01:50:45Z
dc.date.issued2020-09-01
dc.description.abstractBackground & aims: Stroke is the leading cause of disability in adult life. Oropharyngeal dysphagia occurs in 65–90% of patients, and its identification in the acute phase of stroke can prevent complications. The aim of this study was to verify whether oropharyngeal dysphagia during stroke hospitalization is associated with functional capacity, as assessed by the modified Rankin Scale (mRs), and mortality 90 days after stroke. Materials and methods: A prospective cohort study evaluating 201 patients hospitalized in the Stroke Unit was carried out. Dysphagia was evaluated during hospitalization using both a specific protocol to evaluate swallowing biomechanics and the Functional Oral Intake Scale (FOIS), in which FOIS 1–3 reflects tube feeding, 4–5 reflects oral feeding requiring food consistency changes, and 6–7 reflects oral feeding with no changes in food consistency. An mRs≥3 at 90 days after discharge was considered disability. The data were adjusted for the National Institute of Health Stroke Scale score, sex, age, stroke-associated pneumonia, type of stroke, and presence of thrombolysis. The significance level was set at 5%. Results: Of the 201 patients evaluated, 42.8% (86) who had dysphagia were older, had a higher severity of stroke, and pneumonia rate. A FOIS score of 6–7 was a protective factor against disability (mRs≥3) (OR: 0.17; CI: 0.005–0.56; p = 0.004), and tube feeding use at hospital discharge increased the risk of mRs≥3 (OR: 14.97; CI: 2.68–83.65; p = 0.002) and mortality (OR: 9.79; CI: 2.21–43.4; p = 0.003) within 90 days after stroke. Pneumonia was the leading cause of death, however dysphagia and tube feeding at discharge were associated with death from any cause. Conclusion: Dysphagia or tube feeding use at discharge are markers of poor prognosis after the first stroke. Our data suggest the importance of early evaluation of dysphagia and closely monitoring the tube fed patients following stroke.en
dc.description.affiliationDepartment of Internal Medicine Sao Paulo State University (Unesp) Medical School
dc.description.affiliationDepartment of Neurology Psychology and Psychiatry Sao Paulo State University (Unesp) Medical School
dc.description.affiliationUnespDepartment of Internal Medicine Sao Paulo State University (Unesp) Medical School
dc.description.affiliationUnespDepartment of Neurology Psychology and Psychiatry Sao Paulo State University (Unesp) Medical School
dc.description.sponsorshipCoordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
dc.description.sponsorshipFundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)
dc.format.extent2786-2792
dc.identifierhttp://dx.doi.org/10.1016/j.clnu.2019.11.042
dc.identifier.citationClinical Nutrition, v. 39, n. 9, p. 2786-2792, 2020.
dc.identifier.doi10.1016/j.clnu.2019.11.042
dc.identifier.issn1532-1983
dc.identifier.issn0261-5614
dc.identifier.scopus2-s2.0-85076832978
dc.identifier.urihttp://hdl.handle.net/11449/199840
dc.language.isoeng
dc.relation.ispartofClinical Nutrition
dc.sourceScopus
dc.subjectDisability
dc.subjectOropharyngeal dysphagia
dc.subjectStroke
dc.subjectTube feeding
dc.titleDysphagia and tube feeding after stroke are associated with poorer functional and mortality outcomesen
dc.typeArtigo
unesp.author.lattes4563764623232492[7]
unesp.author.orcid0000-0003-2227-7505[1]
unesp.author.orcid0000-0002-9831-8820[6]
unesp.author.orcid0000-0002-2875-9532[7]

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Artigos - Clínica Médica - FMB
Artigos - Neurologia, Psicologia e Psiquiatria - FMB