Radiomics Derived Brain Age Predicts Functional Outcome After Acute Ischemic Stroke

Abstract While chronological age is one of the most influential determinants of post-stroke outcomes, little is known of the impact of neuroimaging-derived biological brain age. We here first examine whether radiomics analysis of the texture of brain T2-FLAIR MRI images can be used to predict brain age in stroke patients. We then assess the clinical determinants of accelerated brain aging and, finally, its impact on post-stroke functional outcomes. Leveraging a multisite cohort of 4,163 ischemic stroke patients, we show that older-appearing patients have more hypertension, diabetes mellitus, prior strokes, and smoking history and are more likely to develop worse post-stroke outcomes than their younger-appearing counterparts. Our results strengthen the importance of preventive medicine for maintaining brain health in stroke patients as they age and suggest a novel methodology to capture previously undescribed prognostic information available on commonly acquired MRI sequences during routine stroke care.

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The stroke mothership model survived during COVID-19 era: an observational single-center study in Emilia-Romagna, Italy

Neurological Sciences ◽

10.1007/s10072-020-04754-2 ◽

2020 ◽

Vol 41 (12) ◽

pp. 3395-3399

Author(s):

Andrea Zini ◽

Michele Romoli ◽

Mauro Gentile ◽

Ludovica Migliaccio ◽

Cosimo Picoco ◽

...

Keyword(s):

Ischemic Stroke ◽

Treatment Time ◽

Combined Treatment ◽

Temporal Trends ◽

Stroke Care ◽

Minor Stroke ◽

Care Organization ◽

Stroke Patients ◽

Stroke Center ◽

The Impact

Abstract Introduction A reduction of the hospitalization and reperfusion treatments was reported during COVID-19 pandemic. However, high variability in results emerged, potentially due to logistic paradigms adopted. Here, we analyze stroke code admissions, hospitalizations, and stroke belt performance for ischemic stroke patients in the metropolitan Bologna region, comparing temporal trends between 2019 and 2020 to define the impact of COVID-19 on the stroke network. Methods This retrospective observational study included all people admitted at the Bologna Metropolitan Stroke Center in timeframes 1 March 2019–30 April 2019 (cohort-2019) and 1 March 2020–30 April 2020 (cohort-2020). Diagnosis, treatment strategy, and timing were compared between the two cohorts to define temporal trends. Results Overall, 283 patients were admitted to the Stroke Center, with no differences in demographic factors between cohort-2019 and cohort-2020. In cohort-2020, transient ischemic attack (TIA) was significantly less prevalent than 2019 (6.9% vs 14.4%, p = .04). Among 216 ischemic stroke patients, moderate-to-severe stroke was more represented in cohort-2020 (17.8% vs 6.2%, p = .027). Similar proportions of patients underwent reperfusion (45.9% in 2019 vs 53.4% in 2020), although a slight increase in combined treatment was detected (14.4% vs 25.4%, p = .05). Door-to-scan timing was significantly prolonged in 2020 compared with 2019 (28.4 ± 12.6 vs 36.7 ± 14.6, p = .03), although overall timing from stroke to treatment was preserved. Conclusion During COVID-19 pandemic, TIA and minor stroke consistently reduced compared to the same timeframe in 2019. Longer stroke-to-call and door-to-scan times, attributable to change in citizen behavior and screening at hospital arrival, did not impact on stroke-to-treatment time. Mothership model might have minimized the effects of the pandemic on the stroke care organization.

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Temporal and Spatial Dynamics of Inflammasome Activation After Ischemic Stroke

Frontiers in Neurology ◽

10.3389/fneur.2021.621555 ◽

2021 ◽

Vol 12 ◽

Author(s):

Danli Lu ◽

Mengyan Hu ◽

Bingjun Zhang ◽

Yinyao Lin ◽

Qiang Zhu ◽

...

Keyword(s):

Ischemic Stroke ◽

Spatial Dynamics ◽

Size Control ◽

Inflammasome Activation ◽

Therapeutic Effects ◽

Ischemic Lesion ◽

Stroke Outcomes ◽

Post Stroke ◽

Caspase 1 ◽

The Impact

Background: The inflammasome represents a highly pro-inflammatory mechanism. It has been identified that inflammasome was activated after ischemic stroke. However, the impact of inflammasomes on stroke outcomes remains contradictory. The participating molecules and the functioning arena of post-stroke inflammasome activation are still elusive.Methods: In the present study, blood samples from stroke patients were collected and analyzed with flow cytometry to evaluate the correlation of inflammasome activation and stroke outcomes. A stroke model was established using male C57/Bl6 mice with transient middle cerebral artery occlusion (tMCAO, 1 h). The dynamics of inflammasome components, cell type, and location of inflammasome activation and the therapeutic effects of inhibiting post-stroke inflammasome executors were evaluated.Results: We found that a high level of inflammasome activation might indicate detrimental stroke outcomes in patients and mice models. Post-stroke inflammasome activation, especially NLRP3, cleaved Caspase-1, cleaved Caspase-11, IL-1β, IL-18, and GSDMD, peaked at 3–5 days and declined at 7 days with the participation of multiple components in mice. Macrophage that infiltrated into the ischemic lesion was the main arena for post-stroke inflammasome activation among myeloid cells according to the data of mice. Among all the members of the Caspase family, Caspase-1 and −11 served as the main executing enzymes. Inhibiting Caspase-1/−11 signaling efficiently suppressed DAMPs-induced macrophage inflammasome activation and displayed neuroprotection to stroke models including infarct size (Control: 48.05 ± 14.98; Cas1.i: 19.34 ± 12.21; Cas11.i: 21.43 ± 14.67, P < 0.001) and neurological deficit score (0 d-Control: 2.20 ± 0.63; 0 d-Cas1.i: 2.20 ± 0.63; 0 d-Cas11.i: 2.20 ± 0.63; 1 d-Control: 2.50 ± 0.53; 1 d-Cas1.i: 1.50 ± 0.71; 1 d-Cas11.i: 2.00 ± 0.67; 2 d-Control: 2.30 ± 0.48; 2 d-Cas1.i: 1.30 ± 0.48; 2 d-Cas11.i: 1.50 ± 0.53; 3 d-Control: 2.00 ± 0.67; 3 d-Cas1.i: 1.20 ± 0.42; 3 d-Cas11.i: 1.30 ± 0.48, P < 0.001).Conclusions: Taken together, inflammasome activation played a detrimental role in stroke pathology. Targeting post-stroke inflammasome executing enzymes fitting in the dynamics of macrophages might obtain potential and efficient therapeutic effects.

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Abstract T P165: Women Had Worse Stroke Outcome

Stroke ◽

10.1161/str.46.suppl_1.tp165 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Claudia Alonzo ◽

Maria C Zurru ◽

Laura Brescacin ◽

Santiago Pigretti ◽

Pedro Colla Machado ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Ischemic Stroke ◽

Vascular Risk Factor ◽

Stroke Outcome ◽

Vascular Risk ◽

Stroke Patients ◽

Stroke Outcomes ◽

Post Stroke ◽

Artery Disease

Background: women who have ischemic strokes are on average older than men.Several studies, however, show that stroke outcomes are worse in women even after adjusting for age, and the specific conditions that contribute to this outcome are poorly known. Our objective was to evaluate post-stroke disability and mortality after ischemic stroke in women. Methods: acute ischemic stroke patients were prospectively included in a multidisciplinary secondary stroke prevention program. Pre-stroke vascular risk factor profile and control were obtained from electronic records; disability (modified Rankin scale) were evaluated one month after stroke. Results: fifty seven percent of the 1194 ischemic stroke patients prospectively included between December 2006 and December 2013 were women. They were older, more probably hypertensive, dislipidemic and diabetic, and had higher incidence of atrial fibrillation, while men had higher prevalence of obesity, metabolic syndrome, smoking, and history of coronary heart disease and peripheral artery disease. Pre-stroke vascular risk factor control and management are shown in table 1. Women had worst outcome than men: mRankin >1 (66% women vs 52% men, p 0.0001), 30-day mortality (4% women vs 2% men, p 0.04), composite disability + mortality (52% women vs 36% men, p 0.0001). After adjusting by age women still had higher risk of disability and mortality: m-Rankin >1 (OR 1.40, 95%CI 1.05-1.87; p 0.02); mortality (OR 1.64, 95%CI 0,98-2,74), and composite disability + mortality (OR 1.59, 95%CI 1.22-2.07; p 0.004). Conclusion: in our cohort women have worst post-stroke outcome, even though they have higher burden of vascular risk factors they have lower prevalence of vascular disease in other vascular beds previous to stroke. This difference persists after adjusting by age, raising the possibility of specific gender risk factors influencing on ischemic stroke outcomes.

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Abstract WP307: Molecular Mechanisms, Temporal and Spatial Dynamics of Inflammasome Activation in Ischemic Stroke

Stroke ◽

10.1161/str.51.suppl_1.wp307 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Wei Cai ◽

Mengyan Hu ◽

Zhengqi Lu

Keyword(s):

Ischemic Stroke ◽

Molecular Mechanisms ◽

Spatial Dynamics ◽

Inflammasome Activation ◽

Therapeutic Effects ◽

Stroke Patients ◽

Stroke Outcomes ◽

Post Stroke ◽

Caspase 1 ◽

Temporal And Spatial

Background: Multiple sensors, executors and products are involved in inflammasome activation. Inflammasome activation has been found in several immune cells after stroke. However, the molecular mechanisms, the temporal and spatial dynamics of inflammasome activation in stroke remain elusive. Therapeutic value of modifying inflammasome activation in stroke is still debatable. Methods: Inflammasome markers of NLRP3 and IL-1β in stroke patients and healthy control were evaluated with flow cytometry. Correlation of NLRP3/IL-1β expression with stroke outcomes of patients was assessed. Ischemic stroke was induced in mice with transient middle cerebral artery occlusion (tMCAO, 1h). Expression dynamics of inflammasome components, location and cellular target of inflammasome activation in tMCAO models were analyzed. Therapeutic effects of inhibiting inflammasome activation on stroke outcomes were evaluated. Results: Rapid increase of inflammasome markers NLRP3 and IL-1β was detected at 1d after disease onset in stroke patients, which was positively correlated with patients’ infarct volume and NIHSS score. The sensors of NLRP3 and NLRC4 were involved in post stroke inflammasome activation, which increased at 1-3d after stroke and peaked at 3-5d in tMCAO models. Similar dynamics of the executors cleaved Caspase-1/11, as well as the products IL-1β, IL-18 and GSDMD were detected. AIM2 and Caspase-8 seemed not to take any part in post-stroke inflammasome activation. Macrophage was demonstrated as the main cell in which inflammasome was formed in both patients and mice, while microglia, dendritic cells and neutrophil also had inflammasome formation. Inflammasome activation of macrophage was mostly detected in stroke lesion. The executors of Caspase-1 and -11 were the key factors in inflammasome activation in stroke. Preventing inflammasome activation by inhibiting Caspase-1/11 signalings showed promising therapeutic efficacy. Conclusion: The impact of inflammasome activation is detrimental to ischemic stroke. Inhibiting Caspase-1/11 signalings is a promising therapeutic strategy for stroke.

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The impact of post-stroke complications on in-hospital mortality depends on stroke severity

European Stroke Journal ◽

10.1177/2396987316681872 ◽

2016 ◽

Vol 2 (1) ◽

pp. 54-63 ◽

Cited By ~ 7

Author(s):

Alejandro Bustamante ◽

Dolors Giralt ◽

Teresa García-Berrocoso ◽

Marta Rubiera ◽

José Álvarez-Sabín ◽

...

Keyword(s):

Ischemic Stroke ◽

Random Forest ◽

Hospital Mortality ◽

Brain Edema ◽

Respiratory Infections ◽

National Institutes Of Health ◽

Stroke Severity ◽

Stroke Patients ◽

Post Stroke ◽

The Impact

Introduction Controversies remain on whether post-stroke complications represent an independent predictor of poor outcome or just a reflection of stroke severity. We aimed to identify which post-stroke complications have the highest impact on in-hospital mortality by using machine learning techniques. Secondary aim was identification of patient’s subgroups in which complications have the highest impact. Patients and methods Registro Nacional de Ictus de la Sociedad Española de Neurología is a stroke registry from 42 centers from the Spanish Neurological Society. Data from ischemic stroke patients were used to build a random forest by combining 500 classification and regression trees, to weight up the impact of baseline characteristics and post-stroke complications on in-hospital mortality. With the selected variables, a logistic regression analysis was performed to test for interactions. Results 12,227 ischemic stroke patients were included. In-hospital mortality was 5.9% and median hospital stay was 7(4–10) days. Stroke severity [National Institutes of Health Stroke Scale > 10, OR = 5.54(4.55–6.99)], brain edema [OR = 18.93(14.65–24.46)], respiratory infections [OR = 3.67(3.02–4.45)] and age [OR = 2.50(2.07–3.03) for >77 years] had the highest impact on in-hospital mortality in random forest, being independently associated with in-hospital mortality. Complications have higher odds ratios in patients with baseline National Institutes of Health Stroke Scale <10. Discussion Our study identified brain edema and respiratory infections as independent predictors of in-hospital mortality, rather than just markers of more severe strokes. Moreover, its impact was higher in less severe strokes, despite lower frequency. Conclusion Brain edema and respiratory infections were the complications with a greater impact on in-hospital mortality, with the highest impact in patients with mild strokes. Further efforts on the prediction of these complications could improve stroke outcome.

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Abstract WP56: Impact of Perfusion and Diffusion Lesion Load in the Corticospinal Tract on Response to Reperfusion

Stroke ◽

10.1161/str.48.suppl_1.wp56 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Ying Zhou ◽

Ruiting Zhang ◽

Sheng Zhang ◽

Shenqiang Yan ◽

Ze Wang ◽

...

Keyword(s):

Ischemic Stroke ◽

Odds Ratio ◽

Corticospinal Tract ◽

Lesion Volume ◽

Imaging Data ◽

Stroke Patients ◽

Prognostic Information ◽

Anterior Circulation ◽

Good Outcome ◽

The Impact

Objective: To examine the impact of corticospinal tract (CST) involvement in acute ischemic stroke patients on functional outcome and the interaction with reperfusion. Methods: We retrospectively examined clinical and imaging data in consecutive anterior circulation ischemic stroke patients undergoing thrombolysis. MRI perfusion (time to maximum of tissue residue function, Tmax) and apparent diffusion coefficient (ADC) images were transformed into standard space and the volumes of CST involvement by Tmax > 6s (CST-Tmax) and ADC < 600х10 -6 mm 2 /s (CST-ADC) lesions were calculated. Good outcome was defined as modified Rankin Scale ≤ 2 at 3 months. Reperfusion was defined as a reduction in Tmax > 6s lesion volume of ≥ 70% between baseline and 24 hours. Results: A total of 82 patients were included. Binary logistic regression revealed that both CST-Tmax volume (odds ratio, 1.4, p = 0.008) and CST-ADC volume (odds ratio, 4.9, p = 0.002) at baseline were significantly associated with poor outcome. The 24-hour CST-ADC volume was correlated with baseline CST-ADC volume in patients with reperfusion (r = 0.79, p < 0.001) and with baseline CST-Tmax volume in patients without reperfusion (r = 0.67, p < 0.001). In patients with CST-Tmax volume > 0 mL and CST-ADC volume < 3 mL, the rate of good outcome was higher in patients with reperfusion than those without (70.4% vs 38.1%, p =0.04). Interpretation: The use of CST-Tmax in combination with CST-ADC provides prognostic information beyond that provided by mismatch volumes in patients considered for reperfusion therapies.

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Long term Post-Stroke Functional Outcomes: a comparison of diabetics and non-diabetics

Cerebrovascular Diseases Extra ◽

10.1159/000521442 ◽

2021 ◽

Author(s):

Deidre Anne de Silva ◽

Kaavya Narasimhalu ◽

Ian Wang Huang ◽

Fung Peng Woon ◽

John C. Allen ◽

...

Keyword(s):

Ischemic Stroke ◽

Functional Outcome ◽

Functional Outcomes ◽

Age Group ◽

Stroke Patients ◽

Poor Functional Outcome ◽

Post Stroke ◽

The Impact

Introduction: Diabetes mellitus (DM) is known to influence outcomes in the short-term following stroke. However, the impact of DM on long-term functional outcomes after stroke is unclear. We compared functional outcomes periodically over 7 years between diabetic and non-diabetic ischemic stroke patients and investigated the impact of DM on the long-term trajectory of post-stroke functional outcomes. We also studied the influence of age on the diabetes-functional outcome association. Methods: This is a longitudinal observational cohort study of 802 acute ischemic stroke patients admitted to the Singapore General Hospital from 2005 to 2007. Functional outcomes were assessed using the modified Rankin Scale (mRS) with poor functional outcome defined as mRS≥3. Follow-up data was determined at 6 months and at median follow-up durations of 29 and 86 months. Results: Among the 802 ischemic stroke patients studied (mean age 64 ± 12 years, male 63%), 42% had DM. In regression analyses adjusting for covariates, diabetic patients were more likely to have poor functional outcomes at 6 months (OR=2.12, 95% CI: 1.23–3.67) and at median follow-up durations of 29 months (OR=1.96, 95% CI: 1.37–2.81) and 86 months (OR=2.27, 95% CI: 1.58–3.25). In addition, age modulated the effect of DM, with younger stroke patients (≤65 years) more likely to have long term poor functional outcome at the 29-month (p=0.0179) and 86-month (p=0.0144) time points. Conclusions: DM was associated with poor functional outcomes following ischemic stroke in the long term with the effect remaining consistent throughout the 7-year follow-up period. Age modified the effect of DM in the long term, with an observed increase in risk in the ≤65 age group but not in the >65 age group.

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High Neutrophil–Lymphocyte Ratio Predicts Post-stroke Cognitive Impairment in Acute Ischemic Stroke Patients

Frontiers in Neurology ◽

10.3389/fneur.2021.693318 ◽

2021 ◽

Vol 12 ◽

Author(s):

Minwoo Lee ◽

Jae-Sung Lim ◽

Chul-Ho Kim ◽

Sang-Hwa Lee ◽

Yerim Kim ◽

...

Keyword(s):

Ischemic Stroke ◽

Cognitive Impairment ◽

Systemic Inflammation ◽

Cognitive Outcomes ◽

Stroke Patients ◽

Neutrophil Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

Post Stroke ◽

Increased Risk ◽

The Impact

Background and Aims: Systemic inflammation is associated with an increased risk of cognitive impairment and dementia, but the associations between them in stroke patients are less clear. We examined the impact of systemic inflammation represented as the neutrophil-lymphocyte ratio (NLR) on the development of post-stroke cognitive impairment (PSCI) and domain-specific cognitive outcomes 3-month after ischemic stroke.Methods: Using prospective stroke registry data, we consecutively enrolled 345 participants with ischemic stroke whose cognitive functions were evaluated 3-month after stroke. Their cognition was assessed with the Korean version of the Vascular Cognitive Impairment Harmonization Standards and the Korean-Mini Mental Status Examination. PSCI was defined as a z-score of < -2 standard deviations for age, sex, and education adjusted means in at least one cognitive domain. The participants were categorized into five groups according to the quintiles of NLR (lowest NLR, Q1). The cross-sectional association between NLR and PSCI was assessed using multiple logistic regression, adjusting for age, sex, education, vascular risk factors, and stroke type.Results: A total of 345 patients were enrolled. The mean age was 63.0 years and the median NIHSS score and NLR were 2 [1–4] and 2.26 [1.65–2.91], respectively. PSCI was identified in 71 (20.6%) patients. NLR was a significant predictor for PSCI both as a continuous variable (adjusted OR, 1.14; 95% CI, 1.00–1.31) and as a categorical variable (Q5, adjusted OR, 3.26; 95% CI, 1.17–9.08). Patients in the Q5 group (NLR ≥ 3.80) showed significantly worse performance in global cognition and in visuospatial and memory domains.Conclusions: NLR in the acute stage of ischemic stroke was independently associated with PSCI at 3 months after stroke, and high NLR was specifically associated with cognitive dysfunction in the memory and visuospatial domains. Thus, systemic inflammation may be a modifiable risk factor that may influence cognitive outcomes after stroke.

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POST-STROKE DEPRESSION (MODERN LOOK AT THE PROBLEM AND OWN RESEARCH)

East European Journal of Parkinson`s Disease and Movement Disorders ◽

10.33444/2414-0007.6.1-2.10-19 ◽

2020 ◽

Vol 6 (1-2) ◽

pp. 10-19

Author(s):

O.P. Onopriyenko

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Functional Dependence ◽

Recovery Period ◽

Stroke Patients ◽

Early Recovery ◽

Post Stroke ◽

Post Stroke Depression ◽

The Impact

The high incidence and increase in disability among the population after a stroke is a topical problem worldwide in the second decade of the 21st century. Brain strokes, their complications (dementias, depression), place a heavy burden on the society of the country, the families of patients. Objective: To investigate the impact of psychogenic factors on the epidemiology of stroke in Brоvаry district of Kyiv region for the last 10 years, to compile statistics and to compare them with world and regional data of Kyiv region and Ukraine. Methods. The resources of PubMed (1990-2016) and UpToDate (2016) were used to write the review article. To address these issues and to improve the quality of care provided to patients in the Kyiv region, Brovary and Brovary district, an epidemiological study of stroke patients and its risk factors has been continued. We screened 771 patients with stroke in the angioneurology department of the Brоvаry Multidisciplinary Clinical Hospital of the Kyiv region for psycho-emotional depressive disorders in the acute and late recovery period of ischemic stroke using NIHSS scales, Bartel index, modified Rankin scale, RASS scale. Statistical analysis of the obtained data was performed using the Spearman correlation coefficient, multiple regression analysis, descriptive statistics methods. Results. The risk factors for depression in the early recovery period after ischemic stroke and the association of post-stroke depression (PSD) with the risk of recurrence have been identified. 771 stroke patients (13%) had anxiety-depressive syndrome: 436 (56%) man, 335 (44%) women. PSD has been found to be more pronounced in old people, female, single patients. The development of PSD is influenced by many factors, including severity of stroke, disease course, significant functional impairment and degree of disability, reduced cognitive, language functions, and dependence on outsiders. The more pronounced severity of PSD is related to the degree of functional dependence and language-cognitive status. Conclusions. The presence of PSD results in worst prognosis of stroke of functional and cognetiv renewal of patients, increases their dependence on an extraneous help, considerably worsens quality of life. The origin of PSD has multifactorial genesis, mostly psychogenicsocial factor, influences on the degree of functional dependence of patients, especially aphasia. Influence on risk factors will give an opportunity to prevent development of PSD will promote it to effective rehabilitation and prevantion of repeated ischemic stroke. Keywords: ischemic stroke, psychogenic factors, post-stroke depression, principles of rehabilitation, treatment, prevention.

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Dysphagia in Patients with Acute Ischemic Stroke: Early Dysphagia Screening May Reduce Stroke-Related Pneumonia and Improve Stroke Outcomes

Cerebrovascular Diseases ◽

10.1159/000445299 ◽

2016 ◽

Vol 42 (1-2) ◽

pp. 81-89 ◽

Cited By ~ 28

Author(s):

Mohamed Al-Khaled ◽

Christine Matthis ◽

Andreas Binder ◽

Jonas Mudter ◽

Joern Schattschneider ◽

...

Keyword(s):

Logistic Regression ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Case Fatality ◽

National Institutes Of Health ◽

Modified Rankin Scale ◽

Stroke Patients ◽

Stroke Outcomes ◽

Increased Risk ◽

Reduced Risk

Background: Dysphagia is associated with poor outcome in stroke patients. Studies investigating the association of dysphagia and early dysphagia screening (EDS) with outcomes in patients with acute ischemic stroke (AIS) are rare. The aims of our study are to investigate the association of dysphagia and EDS within 24 h with stroke-related pneumonia and outcomes. Methods: Over a 4.5-year period (starting November 2007), all consecutive AIS patients from 15 hospitals in Schleswig-Holstein, Germany, were prospectively evaluated. The primary outcomes were stroke-related pneumonia during hospitalization, mortality, and disability measured on the modified Rankin Scale ≥2-5, in which 2 indicates an independence/slight disability to 5 severe disability. Results: Of 12,276 patients (mean age 73 ± 13; 49% women), 9,164 patients (74%) underwent dysphagia screening; of these patients, 55, 39, 4.7, and 1.5% of patients had been screened for dysphagia within 3, 3 to <24, 24 to ≤72, and >72 h following admission. Patients who underwent dysphagia screening were likely to be older, more affected on the National Institutes of Health Stroke Scale score, and to have higher rates of neurological symptoms and risk factors than patients who were not screened. A total of 3,083 patients (25.1%; 95% CI 24.4-25.8) had dysphagia. The frequency of dysphagia was higher in patients who had undergone dysphagia screening than in those who had not (30 vs. 11.1%; p < 0.001). During hospitalization (mean 9 days), 1,271 patients (10.2%; 95% CI 9.7-10.8) suffered from stroke-related pneumonia. Patients with dysphagia had a higher rate of pneumonia than those without dysphagia (29.7 vs. 3.7%; p < 0.001). Logistic regression revealed that dysphagia was associated with increased risk of stroke-related pneumonia (OR 3.4; 95% CI 2.8-4.2; p < 0.001), case fatality during hospitalization (OR 2.8; 95% CI 2.1-3.7; p < 0.001) and disability at discharge (OR 2.0; 95% CI 1.6-2.3; p < 0.001). EDS within 24 h of admission appeared to be associated with decreased risk of stroke-related pneumonia (OR 0.68; 95% CI 0.52-0.89; p = 0.006) and disability at discharge (OR 0.60; 95% CI 0.46-0.77; p < 0.001). Furthermore, dysphagia was independently correlated with an increase in mortality (OR 3.2; 95% CI 2.4-4.2; p < 0.001) and disability (OR 2.3; 95% CI 1.8-3.0; p < 0.001) at 3 months after stroke. The rate of 3-month disability was lower in patients who had received EDS (52 vs. 40.7%; p = 0.003), albeit an association in the logistic regression was not found (OR 0.78; 95% CI 0.51-1.2; p = 0.2). Conclusions: Dysphagia exposes stroke patients to a higher risk of pneumonia, disability, and death, whereas an EDS seems to be associated with reduced risk of stroke-related pneumonia and disability.

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