Early diaphragm dysfunction assessed by ultrasonography after ischemic stroke: a retrospective cohort study

Diaphragmatic dysfunction (DD) is a prevalent complication in ischemic stroke patients, significantly compromising respiratory function and worsening clinical outcomes. However, early risk factors for post-stroke DD and their prognostic implications remain poorly understood.

The cohort study enrolled 83 ischemic stroke patients. Demographics and diaphragmatic ultrasound assessments were obtained within 48 hours of admission. Clinical evaluations comprised the Glasgow Coma Scale, National Institutes of Health Stroke Scale, Fugl-Meyer Assessment for upper extremity (FMA-UE), Barthel Index (BI), modified Rankin Scale (mRS), Brunnstrom recovery stages (BRS) along with brain/chest imaging, dysphagia screening, inflammatory markers, arterial blood gas analysis.

The incidence of DD among the 83 ischemic stroke patients was 55.42%. Patients with DD exhibited significantly lower FMA-UE and BI scores, but higher mRS and BRS scores. Laboratory analyses showed significantly higher C-reactive protein, but lower creatine kinase (CK), Pre-albumin, and Creatinine compared to non-DD controls. Diaphragmatic elevation (DE) was observed in 89.13% of DD patients versus only 13.51% of non-DD patients. Moreover, mean diaphragmatic mobility (DM) during quiet breathing was significantly reduced in the DD group. Both DM (r = 0.223, p = 0.044) and DE (r = 0.270, p = 0.014) showed significant independent correlations with mRS scores. Regression analysis identified mRS (β = 0.310; T = 2.097; p = 0.041), Creatinine (β = 0.308; T = 2.206; p = 0.032), pneumonia (β = 0.332; T = 2.625; p = 0.011), and DE (β = 0.331; T = 2.308; p = 0.025) as significant predictors of DM.

Significant risk factors for DD include advanced age, poor nutritional status, concurrent pneumonia, lower CK levels, and greater neurological impairment severity measured by FMA-UE, BI, mRS and BRS.