Comprehensive Evaluation of Prognostic Factors Affecting Dysphagia after Stroke: an Umbrella Review
摘要
Background Post-stroke dysphagia (PSD) is a common and severe complication of stroke, significantly reducing patients' quality of life and increasing mortality risk. Although multiple factors have been proposed to correlate with PSD prognosis, the quality of evidence supporting these associations remains systematically underevaluated. Objective To systematically evaluate risk and protective factors influencing PSD prognosis and assess the quality of evidence for each factor. Methods Eight databases (PubMed, Web of Science, Cochrane Library, Embase, CNKI, Wanfang Data, VIP, and SinoMed) were searched from their inception to November 3, 2024 to identify systematic reviews investigating prognostic factors for PSD. The methodological quality of the included reviews was appraised using the AMSTAR 2 checklist. A four-tiered evidence grading system was applied to evaluate the certainty of the prognostic factors. Data from all relevant original studies within the systematic reviews were synthesized and re-analyzed using Stata 16 and RevMan 5.4. Results Five systematic reviews (encompassing 39 original studies) were included, identifying 45 prognostic factors associated with PSD. Only one factor (impaired consciousness) was supported by strong evidence. Nine factors—age, sex, cognitive impairment, dysphagia severity, malnutrition, bilateral stroke, activities of daily living, NIHSS score, and mRS score—demonstrated highly suggestive evidence, while the remaining factors were supported by weak evidence. Conclusion Prognostic factors for PSD can be categorized into reversible and irreversible determinants. Clinical interventions should prioritize modifiable factors to optimize rehabilitation outcomes. Further high-quality studies are warranted to validate these associations and refine evidence-based management strategies.