脱水与吞咽困难共存时的院内死亡率：来自全国性GEMIDAS Pro登记研究的结果

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中文摘要

目的： 脱水在老年住院成人中常见，但其预后意义及其与吞咽困难在急性老年医学照护中的关系仍不确定。我们研究了脱水的患病率、临床特征和住院结局，并评估在考虑吞咽困难后脱水是否仍与院内死亡率独立相关。
方法： 我们分析了GEMIDAS Pro登记研究中2006年至2024年间德国急性老年住院患者的数据。我们纳入年龄≥65岁的住院患者。脱水和吞咽困难根据主要或次要ICD-10-GM诊断确定。多变量logistic回归分析了与脱水和院内死亡率相关的因素。采用四组模型根据吞咽困难和脱水分别存在及共同存在的情况评估死亡率。
结果： 在1,343,561例住院患者中，脱水记录于177,091例（13.2%）。与无脱水者相比，脱水患者的认知和功能状态较低，存活者中功能改善较少，院内死亡率较高（5.8% vs 2.6%）。吞咽困难与脱水独立相关。在纳入吞咽困难进行调整后，脱水仍与院内死亡独立相关（调整OR 1.35，95% CI 1.32-1.38），吞咽困难亦然（调整OR 1.68，95% CI 1.64-1.73）。死亡率从两者均无时的2.2%升至仅脱水时的4.7%、仅吞咽困难时的8.6%，以及两者均存在时的12.1%。合并组的调整死亡比值比最高（OR 2.12，95% CI 2.03-2.21）。
结论： 脱水在急性老年医学照护中常见，并与不良住院结局相关。其与吞咽困难的重叠识别出一个脆弱亚组，支持在临床照护中综合考虑吞咽与补液。

英文摘要

PURPOSE: Dehydration is common in older hospitalized adults, but its prognostic relevance and relationship with dysphagia in acute geriatric care remain uncertain. We examined the prevalence, clinical profile, and hospital outcomes of dehydration and whether it was independently associated with in-hospital mortality after accounting for dysphagia.
METHODS: We analyzed data from the GEMIDAS Pro registry on acute geriatric inpatient admissions in Germany between 2006 and 2024. We included admissions aged ≥ 65 years. Dehydration and dysphagia were identified from main or secondary ICD-10-GM diagnoses. Multivariable logistic regression examined factors associated with dehydration and in-hospital mortality. A four-group model assessed mortality according to the separate and combined presence of dysphagia and dehydration.
RESULTS: Among 1,343,561 admissions, dehydration was documented in 177,091 (13.2%). Admissions with dehydration had lower cognitive and functional status, less functional improvement among survivors, and higher in-hospital mortality than those without dehydration (5.8% vs 2.6%). Dysphagia was independently associated with dehydration. After adjustment including dysphagia, dehydration remained independently associated with in-hospital death (adjusted OR 1.35, 95% CI 1.32-1.38), as did dysphagia (adjusted OR 1.68, 95% CI 1.64-1.73). Mortality increased from 2.2% with neither condition to 4.7% with dehydration alone, 8.6% with dysphagia alone, and 12.1% when both were present. The combined group had the highest adjusted odds of mortality (OR 2.12, 95% CI 2.03-2.21).
CONCLUSION: Dehydration was common and associated with adverse hospital outcomes in acute geriatric care. Its overlap with dysphagia identified a vulnerable subgroup and supports combined consideration of swallowing and hydration in clinical care.