住院成年患者口咽性吞咽困难和营养不良的患病率及临床相关因素：一项前瞻性观察性研究。

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中文摘要

引言： 本研究旨在评估住院成年患者口咽性吞咽困难（OD）和营养不良的患病率及临床相关因素，并描述基线时患有OD的患者6个月结局的特征。
方法： 共纳入1955例连续住院于三级中心的患者（平均±标准差年龄：56.8±16.23岁，54.8%为男性）。记录进食评估工具（EAT-10）、微型营养评估（MNA）、功能性经口摄食量表（FOIS）和Holden功能性步行分类量表（Holden FAC）的数据。基线时诊断为吞咽困难的患者在6个月时重新评估。
结果： 分别有42.5%和22.6%的患者存在营养不良和吞咽困难。吞咽困难症状非常普遍（22.5%至66.8%）。多变量分析显示，EAT-10评分升高与MNA评分较低（B，-0.206；95% CI，-0.327至-0.085；p=0.001）、FOIS评分较低（B，-0.902；95% CI，-1.349至-0.455；p<0.001）和非固体饮食类型（B，-1.311；95% CI，-2.169至-0.454；p=0.003）相关。此外，MNA评分降低（营养不良的可能性）由较高的EAT-10评分（B，-0.073；95% CI，-0.114至-0.031；p=0.001）、较低的FOIS评分（B，0.440；95% CI，0.191至0.688；p=0.001）、较低的Holden FAC评分（B，0.753；95% CI，0.622至0.883；p<0.001）、非固体饮食（B，-1.178；95% CI，-1.647至-0.710；p<0.001）和既往住院史（B，-0.744；95% CI，-1.259至-0.229；p=0.005）预测。在基线时患有OD的441例患者中，137例（31.1%）死亡，59例（13.4%）失访。在6个月时重新评估的245例患者中，81例（33.1%）OD持续存在，164例（66.9%）OD缓解。持续性OD与较高的基线EAT-10评分以及较低的基线MNA和FOIS评分相关。
结论： 总之，我们的研究结果揭示了住院患者中营养不良与OD并存的高患病率以及非常普遍的吞咽困难症状。重要的是，相当比例的患者在6个月时表现出持续性吞咽困难，凸显了早期识别和长期随访的必要性。OD或营养不良的存在似乎能显著预测彼此的风险，而较高的EAT评分和较低的MNA评分也与较差的活动状态和功能性经口摄食减少相关。

英文摘要

INTRODUCTION: This study aimed to evaluate prevalence and clinical correlates of oropharyngeal dysphagia (OD) and malnutrition in hospitalized adult patients and to characterize 6-month outcomes among patients with OD at baseline.
METHODS: A total of 1955 consecutive patients (mean±SD age: 56.8±16.23 years, 54.8% were males) hospitalized at a tertiary center were included. Data on Eating Assessment Tool (EAT-10), Mini Nutritional Assessment (MNA), functional oral intake scale (FOIS) and Holden functional ambulation classification scale (Holden FAC) were recorded. Patients diagnosed with dysphagia at baseline were re-evaluated at 6 months.
RESULTS: Malnutrition and dysphagia were noted in 42.5% and 22.6% of patients, respectively. Dysphagia symptoms were highly prevalent (22.5% to 66.8%). Multivariate analysis revealed increase in EAT-10 scores with lower MNA scores (B, -0.206; 95% CI, -0.327 to -0.085; p=0.001), lower FOIS scores (B, -0.902; 95% CI, -1.349 to -0.455; p<0.001) and non-solid diet type (B, -1.311; 95% CI, -2.169 to -0.454; p=0.003). In addition, decrease in MNA scores (likelihood of malnutrition) was predicted by higher EAT-10 scores (B, -0.073; 95% CI, -0.114 to -0.031; p=0.001), lower FOIS scores (B, 0.440; 95% CI, 0.191 to 0.688; p=0.001), lower Holden FAC scores (B, 0.753; 95% CI, 0.622 to 0.883; p<0.001), non-solid diet (B, -1.178; 95% CI, -1.647 to -0.710; p<0.001) and previous hospitalization (B, -0.744; 95% CI, -1.259 to -0.229; p=0.005). Of the 441 patients with OD at baseline, 137 (31.1%) died and 59 (13.4%) were lost to follow-up. Among the 245 patients reassessed at 6 months, OD persisted in 81 (33.1%) and resolved in 164 (66.9%). Persistent OD was associated with higher baseline EAT-10 scores and lower baseline MNA and FOIS scores.
CONCLUSION: In conclusion, our findings revealed higher prevalence of malnutrition alongside OD and highly prevalent dysphagia symptoms in hospitalized patients. Importantly, a considerable proportion of patients demonstrate persistent dysphagia at 6 months, highlighting the need for early identification and long-term follow-up. Presence of OD or malnutrition seems to significantly predict the risk of each other, while higher EAT and lower MNA scores were also associated with poor ambulatory status and decreased functional oral intake.