Utility of poststroke dysphagia risk stratification using the Malnutrition Universal Screening Tool (MUST) for patients with acute ischemic stroke.

BACKGROUND

Malnutrition is an independent risk factor for poststroke dysphagia (PSD). The utility of nutritional screening tool for prediction of PSD remains unknown. We aimed to evaluate the efficacy of the Malnutrition Universal Screening Tool (MUST) for PSD risk stratification in patients with acute ischemic stroke.

METHODS

We retrospectively analyzed consecutive patients admitted with acute ischemic stroke between January 2018 and December 2020. Severe PSD (sPSD) was defined using a Functional Oral Intake Scale (FOIS) score of 1-3 on day 14 following admission, indicating dependence on enteral or intravenous nutrition. MUST was retrospectively assessed according to the British Association for Parenteral and Enteral Nutrition guidelines. We determined the prevalence of PSD according to the MUST and evaluated its performance using receiver operating characteristic analysis. Multivariable logistic regression was used to identify any independent association between MUST and sPSD.

RESULTS

Of 796 patients (median age 77 years; 57 % male), 152 (19 %) developed sPSD. The prevalence increased significantly with the MUST (p for trend <0.001). The area under the curve of MUST for sPSD was 0.87 (95 % confidence interval: 0.85-0.89). MUST ≥ 2 yielded a sensitivity of 97.4 % and a specificity of 70.7 % for the prediction of sPSD. On multivariable logistic regression analysis, MUST ≥ 2 was independently associated with sPSD (adjusted odds ratio: 4.93; 95 % confidence interval: 1.31-18.6; p < 0.001).

CONCLUSION

MUST can be used to stratify the risk of sPSD 14 days post-admission in patients with acute ischemic stroke and for the early identification of patients requiring proactive dysphagia management.