Introduction
Studies have generally highlighted three groups of patients at particular risk of dysphagia: the elderly, those with neurological pathology and the critically ill. Over the last decade, there has been increasing interest in the role of critical illness related dysphagia, however, less is known about the impact of infection and sepsis on unwell patients in hospital. In this study, we aimed to assess the prevalence and factors predicting dysphagia in patients with no prior history of dysphagia, admitted to hospital with infections or sepsis.
Aims & Methods
Participants ≥ 18 years of age admitted to hospital with infections or sepsis caused by pneumonia, urine tract infections or cholecystitis were recruited from an NHS Trust. Researchers, electronic patient record administrators and clinical coding staff screened patient data over 12 months from 01/02/2022 to 01/02/2023. All patients with potentially confounding conditions or pathology, such as previous or ongoing dysphagia, acute head injuries or stroke, were excluded. Those that remained had data extracted from their notes, including age, gender, length of stay (LOS), intensive care unit (ICU) admission status, co-morbidities, type of infection/sepsis, obesity, frailty and mortality. Patient data was then subjected to statistical analysis, including Chi-squared, T-Tests, Logistic regression and Cox regression.
Results
Over the study period, 4475 patients (M: 2031, F: 2444) were admitted with infections (Pneumonia 2465, UTI 1888 and Cholecystitis 401). Of these, 189 (4.2%) developed dysphagia (Pneumonia 6.0%, UTI 3.5%, Cholecystitis 0.8%). Additionally, 865 patients (M: 434, F: 431) were admitted with sepsis (Pneumonia 535, UTI 413 and Cholecystitis 55). Of these, 54 (6.2%) had dysphagia (Pneumonia 9.3%, UTI 3.4%, Cholecystitis 3.6%).
Logistic regression revealed that increasing age, the presence of sepsis, delirium, dementia and Parkinson’s disease (PD) were significantly associated with an increased risk of dysphagia (OR 1.02, 1.74, 1.60, 2.43, 3.88; P 0.002, 0.013, 0.008, <0.001, <0.001). Obesity and female gender were associated with a reduced risk of dysphagia (OR 0.53, 0.65; P 0.006, 0.001). Other comorbidities such as diabetes, chronic obstructive pulmonary disease (COPD), cirrhosis and heart failure were not significantly associated with dysphagia. Additionally, Cox regression revealed that increasing age, sepsis, dysphagia, delirium and frailty all significantly increased LOS (HR 0.99, 0.63, 0.59, 0.67, 0.79; P <0.001, <0.001, <0.001, <0.001, <0.001).
Conclusion
Our study has identified that infection and sepsis-associated dysphagia is a major syndrome, with age being a significant determinant. Additionally, patients with PD, delirium or dementia without previous or existing dysphagia are at high risk of developing dysphagia should they be admitted with infections or sepsis. Our novel findings should increase clinical awareness of infection and sepsis-associated dysphagia in hospitalised patients and prompt greater study of this phenomenon.
References
Sasegbon A, O'Shea L, Hamdy S. Examining the relationship between sepsis and oropharyngeal dysphagia in hospitalised elderly patients: a retrospective cohort study. Frontline Gastroenterol. 2018 Oct;9(4):256-261. doi: 10.1136/flgastro-2018-100994. Epub 2018 Jun 2. PMID: 30245787; PMCID: PMC6145432.
Disclosure
None to disclose
