Development and validation of a predictive model for patients with post-extubation dysphagia

doi:10.5847/wjem.j.1920-8642.2023.021

Abstract

Abstract:

BACKGROUND: Swallowing disorder is a common clinical symptom that can lead to a series of complications, including aspiration, aspiration pneumonia, and malnutrition. This study aimed to investigate risk factors of post-extubation dysphagia (PED) in intensive care unit (ICU) patients with endotracheal intubation, and to develop a risk-predictive model for PED, which could serve as an assessment tool for the prevention and control of PED.

METHODS: Patients retrospectively selected from June to December 2021 in a tertiary hospital served as the derivation cohort. Patients recruited from the same hospital from March to June 2022 served as the external validation cohort for the predictive model. We used a combination of variable screening and least absolute shrinkage and selection operator (LASSO) regression to select the most useful candidate predictors and checked the multicollinearity of independent variables using the variance inflation factor method. Multivariate logistic regression analysis was performed to calculate the odds ratio (OR; 95% confidence interval [95% CI]) and P-value for each variable to predict diagnosis. The screened risk factors were introduced into R software to build a nomogram model. The performance of the model, including discrimination ability, calibration, and clinical benefit, was evaluated by plotting the receiver operating characteristic (ROC), calibration, and decision curves.

RESULTS: A total of 305 patients were included in this study. Among them, 235 patients (53 PED vs. 182 non-PED) were enrolled in the derivation cohort, while 70 patients (17 PED vs. 53 non-PED) were enrolled in the validation cohort. The independent predictors included age, pause of sedatives, level of consciousness, activities of daily living (ADL) score, nasogastric tube, sore throat, and voice disorder. These predictors were used to establish the predictive nomogram model. The model demonstrated good discriminative ability, and the area under the ROC curve (AUC) was 0.945 (95% CI 0.904-0.970). Applying the predictive model to the validation cohort demonstrated good discrimination with an AUC of 0.907 (95% CI 0.831-0.983) and good calibration. The decision-curve analysis of this nomogram showed a net benefit of the model.

CONCLUSION: A predictive model that incorporates age, pause of sedatives, level of consciousness, ADL score, nasogastric tube, sore throat, and voice disorder may have the potential to predict PED in ICU patients.

Key words: Post-extubation dysphagia, Nomogram, Predictive model

Jia-ying Tang, Xiu-qin Feng, Xiao-xia Huang, Yu-ping Zhang, Zhi-ting Guo, Lan Chen, Hao-tian Chen, Xiao-xiao Ying. Development and validation of a predictive model for patients with post-extubation dysphagia[J]. World Journal of Emergency Medicine, 2023, 14(1): 49-55.

Figures/Tables 3

Table 1.

Figure 1.

Figure 2.

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Parameters	B	SE	OR (95% CI)	P-value
Age	1.198	0.344	3.131 (1.690-6.496)	<0.001
Pause of sedatives	−0.384	0.105	0.681 (0.554-0.837)	<0.001
Level of consciousness	4.291	1.402	73.035 (4.676-1140.625)	0.002
Activities of daily living (ADL) score	1.920	0.615	6.822 (2.042-18.298)	0.002
Nasogastric tube	1.889	0.486	6.612 (1.955-14.156)	<0.001
Voice disorder	1.179	0.560	3.252 (1.143-10.632)	0.035
Sore throat	1.757	0.471	5.792 (2.302-14.574)	<0.001