COVID-19 is associated with oropharyngeal dysphagia and malnutrition in hospitalized patients during the spring 2020 wave of the pandemic

Alberto Martin-Martinez, Omar Ortega, Paula Viñas, Viridiana Arreola, Weslania Nascimento, Alícia Costa, Stephanie A Riera, Claudia Alarcón, Pere Clavé, Alberto Martin-Martinez, Omar Ortega, Paula Viñas, Viridiana Arreola, Weslania Nascimento, Alícia Costa, Stephanie A Riera, Claudia Alarcón, Pere Clavé

Abstract

Background & aims: Prevalence and complications of oropharyngeal dysphagia (OD) and malnutrition (MN) in COVID-19 patients is unknown. Our aim was to assess the prevalence, risk factors and clinical outcomes of OD and MN in a general hospital during the first wave of the COVID-19 pandemic.

Methods: This was a prospective, observational study involving clinical assessment of OD (Volume-Viscosity Swallowing Test), and nutritional screening (NRS2002) and assessment (GLIM criteria) in COVID-19 patients hospitalized in general wards at the Consorci Sanitari del Maresme, Catalonia, Spain. The clinical characteristics and outcomes of patients were assessed at pre-admission, admission and discharge, and after 3 and 6-months follow-up.

Results: We included 205 consecutive patients (69.28 ± 17.52 years, Charlson 3.74 ± 2.62, mean hospital stay 16.8 ± 13.0 days). At admission, Barthel Index was 81.3 ± 30.3; BMI 28.5 ± 5.4 kg/m2; OD prevalence 51.7% (44.1% impaired safety of swallow); and 45.5% developed MN with a mean weight loss of 10.1 ± 5.0 kg during hospitalization. OD was an independent risk factor for MN during hospitalization (OR 3.96 [1.45-10.75]), and hospitalization was prolonged in patients with MN compared with those without (21.9 ± 14.8 vs 11.9 ± 8.9 days, respectively; p < 0.0001). OD was independently associated with comorbidities, neurological symptoms, and low functionality. At 6-month follow-up, prevalence of OD was still 23.3% and that of MN only 7.1%. Patients with OD at discharge showed reduced 6-month survival than those without OD at discharge (71.6% vs 92.9%, p < 0.001); in contrast, those with MN at discharge did not show 6-month survival differences compared to those without (85.4% vs 83.8%, p = 0.8).

Conclusions: Prevalence and burden of OD and MN in patients hospitalized in COVID-19 wards is very high. Our results suggest that optimizing the management of MN might shorten the hospitalization period but optimizing the management of OD will likely impact the nutritional status of COVID-19 patients and improve their clinical outcomes and survival after hospital discharge.

Clinicaltrials: gov Identifier: NCT04346212.

Keywords: COVID-19; Fluid thickening; Malnutrition; Nutritional risk; Oropharyngeal dysphagia; Swallowing disorders.

Conflict of interest statement

Conflict of interest No competing interests declared. Nutricia-Danone Grant Support: Professor P. Clavé reports grants and contracts from Nutricia Advanced Medical Nutrition outside the submitted work.

Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.

Figures

Fig. 1
Fig. 1
Consort study flow chart for patients included in the study.
Fig. 2
Fig. 2
Change in functional status (Barthel Index) and weight over the 6-month study period according to swallowing and nutritional status.
Fig. 3
Fig. 3
Survival curves of patients with and without OD (A) and MN (B) at hospital discharge A comparison p 

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