Pulmonary function and sarcopenia as predictors of dysphagia in cervical spinal cord injury

Abstract

Abstract Study design: Retrospective cohort study. Objective: To determine the risk factors associated with dysphagia in individuals with cervical spinal cord injury (CSCI) and analyze the differences between individuals with improved penetration-aspiration (PA) and persistent PA on follow-up. Setting: Tertiary inpatient rehabilitation facilities. Methods: Medical records of individuals with CSCI admitted between December 2009 and February 2023 who underwent a videofluoroscopic swallowing study (VFSS) were retrospectively reviewed. Multivariate logistic regression analysis was performed to assess risk factors for dysphagia. Differences between individuals with improved PA and persistent PA were analyzed using an independent t-test. Results: In total, 149 participants were enrolled. Age (odds ratio (OR) 1.077, 95% confidence interval (CI), 1.043 to 1.118), percentage of forced vital capacity to predicted normal (FVC (% predicted)) (OR 0.897, 95% CI, 0.850 to 0.941), and skeletal muscle mass ratio (SMMR) (OR 0.888, 95% CI, 0.791 to 0.991) were significant factors associated with the risk of PA. According to the receiver operating characteristic curve analysis, the cut-off values for age, FVC (% predicted), and SMMR were 55.50, 46.11, and 41.01, respectively. A secondary analysis of the follow-up VFSS was performed in 38 participants. The follow-up FVC(%predicted) and degree of weight loss differed significantly between the improved PA and persistent PA groups. Conclusions: Older age, low FVC (% predicted), and low SMMR can be predictors of dysphagia in patients with CSCI. On follow-up VFSS, individuals with improved PA demonstrated greater improvement in FVC (% predicted).