Predicting Early Dysphagia in Acute Ischemic Stroke Using an Explainable Machine Learning Model

Ye Li,1,2,* Sihao Yu,3,* Xiaojuan Yu,4 Bei Tian,1,5 Jiayan Tang,1,2 Haihong Qu,4 Yongfang Zhang1,5 1Graduate School, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China; 2School of Nursing and Health Management, Shanghai University of Medicine & Health Sciences, Shanghai, People’s Republic of China; 3Department of Nursing, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China; 4Department of Nursing, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, People’s Republic of China; 5Department of Nursing, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, People’s Republic of China*These authors contributed equally to this workCorrespondence: Haihong Qu; Yongfang Zhang, Email 13020268592h@163.com; 93118415@qq.comPurpose: This study aimed to identify key risk factors and develop an explainable machine learning (ML) model for predicting early dysphagia in patients with acute ischemic stroke (AIS).Patients and Methods: In this cross-sectional study, 1041 patients with AIS were recruited from two tertiary hospitals. Participants were classified into a non-dysphagia group (n = 736) and a dysphagia group (n = 305). Feature selection was carried out using the Boruta algorithm and logistic regression. The dataset was randomly partitioned into a training set (n = 728) and a test set (n = 313) in a 7:3 ratio. Six ML models were trained with 10-fold cross-validation. Model performance was evaluated based on the area under the receiver operating characteristic curve (AUC-ROC), sensitivity, specificity, accuracy,positive predictive value (PPV), negative predictive value (NPV), F1-score and Youden’s index. Key predictors were interpreted using SHapley Additive exPlanations (SHAP) analysis.Results: The incidence of early dysphagia with AIS was 29.3%. The Random Forest (RF) model demonstrated the best overall performance, with an AUC-ROC of 0.952 (95% CI: 0.927– 0.976). The significant risk factors identified were Activities of Daily Living (ADL) grade, National Institutes of Health Stroke Scale (NIHSS) score, multifocal lesions, hypoalbuminemia, coronary heart disease, and lesion hemisphere.Conclusion: ML models may serve as reliable assessment tools for predicting dysphagia in patients with AIS. The RF model demonstrated the best predictive performance. This predictive model could assist clinical healthcare providers in delivering early warnings and developing individualized treatment plans for high-risk patients.Keywords: ischemic stroke, dysphagia, machine learning, predictive model, risk factors