{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T09:43:44Z","timestamp":1776159824383,"version":"3.50.1"},"reference-count":26,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T00:00:00Z","timestamp":1775606400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Post-stroke dysphagia is a frequent complication associated with aspiration, malnutrition, and prolonged dependence on enteral feeding. Systemic inflammation and impaired nutritional status may adversely affect neuromuscular recovery; however, their relative and combined associations with swallowing recovery and transition from enteral to oral feeding remain insufficiently characterized. Objective: This study aimed to examine the independent associations of inflammatory and nutritional indices with swallowing function recovery and to evaluate their relationship with enteral-to-oral feeding transition in patients with post-stroke dysphagia. Methods: In this retrospective observational study, patients with dysphagia following ischemic stroke were evaluated before (T0) and after (T1) routine dysphagia rehabilitation. Inflammatory indices including the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune\u2013inflammation index (SII), systemic inflammation response index (SIRI), and pan-immune\u2013inflammation value (PIV), as well as the prognostic nutritional index (PNI), were calculated at both time points. Changes in indices (\u0394 = T1 \u2212 T0) were analyzed in relation to changes in swallowing function assessed by the Functional Oral Intake Scale (FOIS) and the Penetration\u2013Aspiration Scale (PAS). Results: Changes in PNI were independently associated with greater improvement in functional oral intake (\u0394FOIS) and reductions in aspiration severity for both liquid and soft consistencies (\u0394PAS; all p &lt; 0.01). In contrast, changes in inflammatory indices (\u0394SIRI, \u0394SII, \u0394PLR, and \u0394PIV) were consistently associated with less favorable swallowing outcomes. In multivariable logistic regression analysis, baseline stroke severity (NIHSS) was the only independent determinant of transition from enteral to oral feeding (OR = 0.72, p = 0.002). The model demonstrated good discrimination (AUC = 0.81). Conclusions: Changes in nutritional status, as reflected by \u0394PNI over time, were the biomarker most consistently associated with functional swallowing recovery and reduced aspiration severity in patients with post-stroke dysphagia. While inflammatory burden was associated with less favorable swallowing physiology, transition from enteral to oral feeding appeared to be primarily driven by neurological severity rather than inflammatory or nutritional indices alone. These findings may support the clinical value of monitoring nutritional reserve alongside inflammatory burden during dysphagia rehabilitation.<\/jats:p>","DOI":"10.3390\/jcm15082833","type":"journal-article","created":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T15:26:39Z","timestamp":1775661999000},"page":"2833","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Neurological Severity Versus Biomarker Dynamics in Post-Stroke Dysphagia: A Dual-Pathway Model for Functional Recovery and Feeding Transition"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7138-2603","authenticated-orcid":false,"given":"Merve","family":"Savas","sequence":"first","affiliation":[{"name":"Department of Speech and Language Therapy, Faculty of Health Sciences, Istanbul Atlas University, 34403 Istanbul, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6938-301X","authenticated-orcid":false,"given":"Senanur","family":"Kahraman Begen","sequence":"additional","affiliation":[{"name":"Department of Speech and Language Therapy, Faculty of Health Sciences, Istanbul Atlas University, 34403 Istanbul, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-2128-2799","authenticated-orcid":false,"given":"Mehmet Serif","family":"Onen","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, Istanbul Atlas University Hospital, 34403 Istanbul, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1347-8498","authenticated-orcid":false,"given":"Hafize","family":"Uzun","sequence":"additional","affiliation":[{"name":"Department of Medical Biochemistry, Faculty of Medicine, Istanbul Atlas University, 34403 Istanbul, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1007\/s13311-016-0483-x","article-title":"Inflammation and Stroke: An Overview","volume":"13","author":"Anrather","year":"2016","journal-title":"Neurotherapeutics"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1016\/S0261-5614(02)00215-7","article-title":"The Impact of Malnutrition on Morbidity, Mortality, Length of Hospital Stay and Costs Evaluated through a Multivariate Model Analysis","volume":"22","author":"Correia","year":"2003","journal-title":"Clin. 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