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

Spinal Cord volume 62, pages 42–49 (2024)Cite this article

Subjects

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) 1.08, 95% confidence interval (CI) 1.04–1.12), percentage of forced vital capacity to predicted normal (FVC (% predicted)) (OR 0.90, 95% CI 0.85–0.94), and skeletal muscle index (OR 0.89, 95% CI, 0.79–0.99) were significant factors associated with the risk of PA. Based on the receiver operating characteristic curve analysis, the cut-off values for age, FVC (% predicted), and skeletal muscle index were determined as 56.0, 45.7, and 41.0, respectively. A secondary analysis of the follow-up VFSS was conducted on 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 skeletal muscle index can be predictors of dysphagia in patients with CSCI. On follow-up VFSS, individuals with improved PA demonstrated greater improvement in FVC (% predicted).

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Fig. 1: Flowchart of participant selection.
Fig. 2: Receiver operating characteristic curve analysis of age (a), FVC (% predicted) (b) and skeletal muscle index (c) to penetration–aspiration.

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Data availability

The authors will freely share the unfiltered raw data underlying the results of this study.

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Funding

The authors received no financial support for the research, authorship, or publication of this article from any other organization.

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Authors and Affiliations

  1. Department and Research Institute of Rehabilitation Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea

    Su Ji Lee & Ji Cheol Shin

Authors
  1. Su Ji Lee
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Contributions

This paper was co-authored by SJL and JCS. JCS contributed as a corresponding author. SJL and JCS contributed equally to data analysis and interpretation. All authors participated in the writing and editing of the manuscript.

Corresponding author

Correspondence to Ji Cheol Shin.

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Competing interests

The authors declare no competing interests.

Ethical approval

The study was approved by the institutional review board of Severance Hospital, Yonsei University Health System, Seoul, Korea (4-2023-0223). Due to the retrospective nature of the study, the review board waived the requirement for informed consent.

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Lee, S.J., Shin, J.C. Pulmonary function and sarcopenia as predictors of dysphagia in cervical spinal cord injury. Spinal Cord 62, 42–49 (2024). https://doi.org/10.1038/s41393-023-00946-7

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