{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T11:16:09Z","timestamp":1788434169644,"version":"build-2803163510"},"reference-count":22,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T00:00:00Z","timestamp":1788393600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background: Post-stroke dysphagia is associated with aspiration pneumonia, malnutrition, and poor functional outcomes. Although systemic biochemical abnormalities are common after stroke, their contribution to swallowing recovery and transition to oral feeding remains unclear. This study investigated the association of systemic biochemical markers with oral feeding transition and swallowing-related functional improvement in patients with chronic post-stroke dysphagia. Methods: This retrospective single-center study included 89 patients with chronic post-stroke dysphagia who received enteral nutrition between February 2023 and December 2025. Biochemical parameters and swallowing outcomes, assessed using the Functional Oral Intake Scale (FOIS) and Penetration\u2013Aspiration Scale (PAS), were retrospectively analyzed. Changes between baseline (T0) and follow-up (T1) were calculated (\u0394 = T1 \u2212 T0). Multivariable logistic and linear regression analyses were performed to identify independent predictors of transition to oral feeding and improvement in aspiration severity. Results: Of the 89 patients, 52 (58.4%) achieved oral feeding. Significant improvements in swallowing function were observed following rehabilitation, as reflected by increased FOIS scores and decreased PAS-soft and PAS-liquid scores (all p &lt; 0.001), together with reductions in CRP (C-reactive protein), D-dimer, white blood cell count, and neutrophil count (all p &lt; 0.05). Patients who achieved oral feeding demonstrated greater improvements in PAS scores (both p &lt; 0.001) and a divergent change in vitamin B12 levels (a decrease among those who transitioned versus an increase among those who remained enterally fed) (p = 0.049). In exploratory multivariable analyses, higher NIHSS (National Institutes of Health Stroke Scale) scores and lower baseline 25-hydroxyvitamin D levels were associated with a lower likelihood of transition to oral feeding (NIHSS OR = 0.78, p = 0.031; vitamin D OR (Odds ratio) = 1.12, p = 0.001), whereas baseline PAS-liquid score was not an independent predictor of transition. In the linear regression analysis of aspiration severity, baseline PAS-liquid score was the strongest predictor of \u0394PAS-liquid (B = \u22120.527, p = 0.001), while lower baseline 25-hydroxyvitamin D was associated with less improvement (B = \u22120.021, p = 0.047). Given the limited sample size and the absence of correction for multiple comparisons, the biochemical associations should be interpreted as exploratory. Conclusions: In patients with chronic post-stroke dysphagia, transition to oral feeding was primarily associated with neurological severity, whereas improvement in aspiration severity was most strongly related to baseline aspiration burden. Lower baseline 25-hydroxyvitamin D showed exploratory associations with both outcomes. Because 25-hydroxyvitamin D did not change significantly during follow-up and the models were underpowered, this association should be regarded as hypothesis-generating rather than clinically established. These biochemical findings require confirmation in larger prospective studies.<\/jats:p>","DOI":"10.3390\/jcm15176834","type":"journal-article","created":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T10:10:33Z","timestamp":1788430233000},"page":"6834","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Neurological Severity and Systemic Biochemical Markers in Relation to Transition to Oral Feeding in Chronic Post-Stroke Dysphagia"],"prefix":"10.3390","volume":"15","author":[{"given":"Timur","family":"Orhanoglu","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Faculty of Medicine, Istanbul Atlas University, 34403 Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Merve","family":"Sava\u015f","sequence":"additional","affiliation":[{"name":"Department of Speech and Language Therapy, Faculty of Health Sciences, Istanbul Atlas University, 34403 Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6938-301X","authenticated-orcid":false,"given":"Senanur","family":"Kahraman Be\u011fen","sequence":"additional","affiliation":[{"name":"Department of Speech and Language Therapy, Faculty of Health Sciences, Istanbul Atlas University, 34403 Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulhalim","family":"Senyigit","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Faculty of Medicine, Istanbul Atlas University, 34403 Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hafize","family":"Uzun","sequence":"additional","affiliation":[{"name":"Department of Medical Biochemistry, Faculty of Medicine, Istanbul Atlas University, 34403 Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2756","DOI":"10.1161\/01.STR.0000190056.76543.eb","article-title":"Dysphagia after stroke: Incidence, diagnosis, and pulmonary complications","volume":"36","author":"Martino","year":"2005","journal-title":"Stroke"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"707","DOI":"10.2340\/16501977-0415","article-title":"A review of the relationship between dysphagia and malnutrition following stroke","volume":"41","author":"Foley","year":"2009","journal-title":"J. Rehabil. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"852","DOI":"10.1016\/j.apmr.2019.11.012","article-title":"Association Between Malnutrition and Outcomes in Patients With Severe Ischemic Stroke Undergoing Rehabilitation","volume":"101","author":"Scrutinio","year":"2020","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1111\/j.1365-277X.2011.01173.x","article-title":"Dietary intake, nutritional status and rehabilitation outcomes of stroke patients in hospital","volume":"24","author":"Nip","year":"2011","journal-title":"J. Hum. Nutr. Diet."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1016\/j.pneurobio.2009.04.004","article-title":"The multi-faceted basis of vitamin B12 (cobalamin) neurotrophism in adult central nervous system: Lessons learned from its deficiency","volume":"88","author":"Scalabrino","year":"2009","journal-title":"Prog. Neurobiol."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Borowicz, W., Ptaszkowska, L., Ma\u0142ecki, R., and Paprocka-Borowicz, M. (2025). The Effect of Vitamin D Supplementation on Functional Outcomes in Patients Undergoing Rehabilitation After an Ischemic Stroke: A Prospective, Single-Blind, Randomized, Placebo-Controlled Study. J. Clin. Med., 14.","DOI":"10.3390\/jcm14061848"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Yuan, B., Yang, T., Yan, T., Cheng, W., and Bu, X. (2021). Relationships Between D-Dimer Levels and Stroke Risk as Well as Adverse Clinical Outcomes After Acute Ischemic Stroke or Transient Ischemic Attack: A Systematic Review and Meta-Analysis. Front Neurol., 12.","DOI":"10.3389\/fneur.2021.670730"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1016\/j.wneu.2021.10.157","article-title":"Biomarkers Predictive of Long-Term Outcome After Ischemic Stroke: A Meta-Analysis","volume":"163","author":"Soldozy","year":"2022","journal-title":"World Neurosurg."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Yoo, J., Hong, J.-H., Lee, S.-J., Kim, Y.-W., Hong, J.M., Kim, C.-H., Choi, J.W., Kang, D.-H., Kim, Y.-S., and Hwang, Y.-H. (2020). Acute Kidney Injury after Endovascular Treatment in Patients with Acute Ischemic Stroke. J. Clin. Med., 9.","DOI":"10.3390\/jcm9051471"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Chen, H., Fu, C., Fang, W., Wang, Z., Zhang, D., and Zhang, H. (2025). Influence of nutritional status on rehabilitation efficacy of patients after stroke-a scoping review. Front Neurol., 16.","DOI":"10.3389\/fneur.2025.1502772"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Ahmadabad, M.A., Naeimi, A., Keymoradzadeh, A., Faghani, S., Ahmadabad, M.A., Boroujeni, N.A., Mohammadpour, H., and Saber, A. (2022). Evaluation of De Ritis (AST\/ALT), ALP\/ALT, and AST\/ALP ratios as prognostic factors in patients with acute ischemic stroke. BMC Neurol., 22.","DOI":"10.1186\/s12883-022-02989-4"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2888","DOI":"10.1161\/STROKEAHA.117.017776","article-title":"\u0393-Glutamyl Transferase as a Risk Factor for All-Cause or Cardiovascular Disease Mortality Among 5912 Ischemic Stroke","volume":"48","author":"Tu","year":"2017","journal-title":"Stroke"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1007\/BF00417897","article-title":"A penetration-aspiration scale","volume":"11","author":"Rosenbek","year":"1996","journal-title":"Dysphagia"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1516","DOI":"10.1016\/j.apmr.2004.11.049","article-title":"Initial psychometric assessment of a functional oral intake scale for dysphagia in stroke patients","volume":"86","author":"Crary","year":"2005","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1016\/S1474-4422(06)70495-1","article-title":"Clinical interpretation and use of stroke scales","volume":"5","author":"Kasner","year":"2006","journal-title":"Lancet Neurol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1093\/biomet\/80.1.27","article-title":"Bias reduction of maximum likelihood estimates","volume":"80","author":"Firth","year":"1993","journal-title":"Biometrika"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2409","DOI":"10.1002\/sim.1047","article-title":"A solution to the problem of separation in logistic regression","volume":"21","author":"Heinze","year":"2002","journal-title":"Stat. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1911","DOI":"10.1210\/jc.2011-0385","article-title":"Evaluation, treatment, and prevention of vitamin D deficiency: An Endocrine Society clinical practice guideline","volume":"96","author":"Holick","year":"2011","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_19","first-page":"1","article-title":"Clinical Predictors of Dysphagia Recovery After Stroke: A Systematic Review","volume":"38","author":"Rumbach","year":"2023","journal-title":"Dysphagia"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"110591","DOI":"10.1016\/j.clinbiochem.2023.110591","article-title":"Effects of vitamin B12 deficiency on risk and outcome of ischemic stroke","volume":"118","author":"Zhou","year":"2023","journal-title":"Clin. Biochem."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"470","DOI":"10.4103\/1673-5374.291381","article-title":"Role of vitamin B12 deficiency in ischemic stroke risk and outcome","volume":"16","author":"Yahn","year":"2021","journal-title":"Neural Regen. Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e32676","DOI":"10.1097\/MD.0000000000032676","article-title":"Serum vitamin D levels and peak cough flow in patients with subacute ischemic stroke","volume":"102","author":"Yoo","year":"2023","journal-title":"Medicine"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/17\/6834\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T10:31:41Z","timestamp":1788431501000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/17\/6834"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,3]]},"references-count":22,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["jcm15176834"],"URL":"https:\/\/doi.org\/10.3390\/jcm15176834","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,3]]}}}