Association Between Alkaline Phosphatase-to-Albumin Ratio and Post-Stroke Dysphagia: A Retrospective Cohort Study from the MIMIC-IV Database

Abstract Background Post-stroke dysphagia is a common and serious complication that significantly increases the risk of aspiration pneumonia, malnutrition, and prolonged hospitalization. The alkaline phosphatase-to-albumin ratio (APAR) has been recognized as a potential biomarker reflecting systemic inflammation and nutritional status, yet its association with post-stroke dysphagia remains unclear. Methods This retrospective cohort study extracted data from the Medical Information Mart for Intensive Care IV (MIMIC-IV, v3.0) database, involving 1563 ICU patients diagnosed with stroke. The primary outcome was the occurrence of post-stroke dysphagia, identified through bedside swallowing screening records (item ID 225118) in the chartevents table. Multivariable logistic regression models were constructed to evaluate the association between APAR and dysphagia, with restricted cubic spline regression for nonlinearity exploration and subgroup analyses for consistency assessment. Results Among the 1,563 included stroke patients, a higher alkaline phosphatase-to-albumin ratio (APAR) was significantly and independently associated with an increased risk of post-stroke dysphagia after adjusting for potential confounders. The restricted cubic spline analysis indicated a nonlinear dose-response relationship between APAR and dysphagia risk. Furthermore, subgroup analyses demonstrated that this positive association was generally consistent across most patient strata. Conclusions Elevated APAR is independently associated with an increased risk of post-stroke dysphagia in critically ill patients. The nonlinear relationship and consistent findings across subgroups suggest that APAR may serve as a useful biomarker for identifying stroke patients at heightened risk of dysphagia, facilitating early risk stratification and targeted interventions.