Liu Huan , Hou Yutong , Shi Jiajia , Liu Wenbo , Zhang Pingping
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AMOS software (version 23.0) was used to construct the structural equation modeling.</div></div><div><h3>Results</h3><div>The overall model showed a good fit (chi-square = 27.3, root mean square error of approximation = 0.01, standardized root mean square residual = 0.032, comparative fit index = 0.98, and adjusted goodness of fit = 0.94). Structural equation modeling showed that the total effect of dysphagia on the prognosis of patients with stroke was 0.694, with a direct effect of 0.599, accounting for 86.31 % of the total effect. The total indirect effect was 0.095, with the mediating effects of serum albumin level and pneumonia accounting for 6.48 % and 7.35 % of the total effect, respectively. The moderating effects of sex on dysphagia and the relationship between activities of daily living, modified Rankin scale score, and length of hospital stay were insignificant (ΔR<sup>2</sup> = 0.063, P = 0.145; ΔR<sup>2</sup> = 0.002, P = 0.620; ΔR<sup>2</sup> = 0.001, P = 0.307).</div></div><div><h3>Conclusions</h3><div>Dysphagia can directly affect the prognostic outcomes of patients with stroke and indirectly affect prognosis by triggering pneumonia and lowering albumin levels. Sex was not found to play a moderating role in the relationship between dysphagia and prognosis.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"66 ","pages":"Pages 1-8"},"PeriodicalIF":2.9000,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Pathway analysis of the impact of dysphagia on the prognosis of patients with stroke: Based on structural equation modeling\",\"authors\":\"Liu Huan , Hou Yutong , Shi Jiajia , Liu Wenbo , Zhang Pingping\",\"doi\":\"10.1016/j.clnesp.2024.12.017\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background and aims</h3><div>Dysphagia is significantly correlated with prognostic outcomes in patients with stroke; however, the intrinsic mechanism of action between the two remains unclear. This study aimed to model the intrinsic mechanism of action between dysphagia and prognostic outcomes in patients with stroke based on structural equation modeling.</div></div><div><h3>Methods</h3><div>A retrospective analysis of 900 inpatients with stroke from three large hospitals was performed. AMOS software (version 23.0) was used to construct the structural equation modeling.</div></div><div><h3>Results</h3><div>The overall model showed a good fit (chi-square = 27.3, root mean square error of approximation = 0.01, standardized root mean square residual = 0.032, comparative fit index = 0.98, and adjusted goodness of fit = 0.94). Structural equation modeling showed that the total effect of dysphagia on the prognosis of patients with stroke was 0.694, with a direct effect of 0.599, accounting for 86.31 % of the total effect. The total indirect effect was 0.095, with the mediating effects of serum albumin level and pneumonia accounting for 6.48 % and 7.35 % of the total effect, respectively. The moderating effects of sex on dysphagia and the relationship between activities of daily living, modified Rankin scale score, and length of hospital stay were insignificant (ΔR<sup>2</sup> = 0.063, P = 0.145; ΔR<sup>2</sup> = 0.002, P = 0.620; ΔR<sup>2</sup> = 0.001, P = 0.307).</div></div><div><h3>Conclusions</h3><div>Dysphagia can directly affect the prognostic outcomes of patients with stroke and indirectly affect prognosis by triggering pneumonia and lowering albumin levels. 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引用次数: 0
摘要
背景与目的：吞咽困难与脑卒中患者预后显著相关；然而，两者之间的内在作用机制尚不清楚。本研究旨在建立基于结构方程模型的脑卒中患者吞咽困难与预后之间的内在作用机制。方法：对3家大型医院住院的900例脑卒中患者进行回顾性分析。采用AMOS 23.0版本软件构建结构方程模型。结果：整体模型拟合良好（卡方= 27.3，近似均方根误差= 0.01，标准化均方根残差= 0.032，比较拟合指数= 0.98，调整拟合优度= 0.94）。结构方程建模结果显示，吞咽困难对脑卒中患者预后的总影响为0.694，直接影响为0.599，占总影响的86.31%。总间接效应为0.095，其中血清白蛋白水平和肺炎的中介效应分别占总效应的6.48%和7.35%。性别对吞咽困难的调节作用及日常生活活动、改良Rankin量表评分与住院时间的关系均不显著(ΔR2 = 0.063, P = 0.145；Δr2 = 0.002, p = 0.620；Δr2 = 0.001, p = 0.307)。结论：吞咽困难可直接影响脑卒中患者的预后，并通过引发肺炎和降低白蛋白水平间接影响预后。没有发现性别在吞咽困难和预后之间的关系中起调节作用。
Pathway analysis of the impact of dysphagia on the prognosis of patients with stroke: Based on structural equation modeling
Background and aims
Dysphagia is significantly correlated with prognostic outcomes in patients with stroke; however, the intrinsic mechanism of action between the two remains unclear. This study aimed to model the intrinsic mechanism of action between dysphagia and prognostic outcomes in patients with stroke based on structural equation modeling.
Methods
A retrospective analysis of 900 inpatients with stroke from three large hospitals was performed. AMOS software (version 23.0) was used to construct the structural equation modeling.
Results
The overall model showed a good fit (chi-square = 27.3, root mean square error of approximation = 0.01, standardized root mean square residual = 0.032, comparative fit index = 0.98, and adjusted goodness of fit = 0.94). Structural equation modeling showed that the total effect of dysphagia on the prognosis of patients with stroke was 0.694, with a direct effect of 0.599, accounting for 86.31 % of the total effect. The total indirect effect was 0.095, with the mediating effects of serum albumin level and pneumonia accounting for 6.48 % and 7.35 % of the total effect, respectively. The moderating effects of sex on dysphagia and the relationship between activities of daily living, modified Rankin scale score, and length of hospital stay were insignificant (ΔR2 = 0.063, P = 0.145; ΔR2 = 0.002, P = 0.620; ΔR2 = 0.001, P = 0.307).
Conclusions
Dysphagia can directly affect the prognostic outcomes of patients with stroke and indirectly affect prognosis by triggering pneumonia and lowering albumin levels. Sex was not found to play a moderating role in the relationship between dysphagia and prognosis.
期刊介绍：
Clinical Nutrition ESPEN is an electronic-only journal and is an official publication of the European Society for Clinical Nutrition and Metabolism (ESPEN). Nutrition and nutritional care have gained wide clinical and scientific interest during the past decades. The increasing knowledge of metabolic disturbances and nutritional assessment in chronic and acute diseases has stimulated rapid advances in design, development and clinical application of nutritional support. The aims of ESPEN are to encourage the rapid diffusion of knowledge and its application in the field of clinical nutrition and metabolism. Published bimonthly, Clinical Nutrition ESPEN focuses on publishing articles on the relationship between nutrition and disease in the setting of basic science and clinical practice. Clinical Nutrition ESPEN is available to all members of ESPEN and to all subscribers of Clinical Nutrition.
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