Risk factors and Outcomes of Dysphagia Among Patients Hospitalized with Acute Intracerebral Hemorrhage: Findings from the Chinese Stroke Center Alliance.
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引用次数: 0
Abstract
Objective: Dysphagia is a common and severe symptom of acute stroke; however, few studies investigated the prevalence of and risk factors of dysphagia among intracerebral hemorrhage (ICH) patients. We aimed to determine the prevalence and risk factors for dysphagia among acute ICH patients, and assess its impact on outcome of hospitalization.
Methods: We collected data of ICH patients from the Chinese Stroke Center Alliance (CSCA) from August 2015 to July 2019 retrospectively. Univariate analysis and multivariable analysis were conducted to identify the factors associated with dysphagia and the outcomes of hospitalization.
Results: 32 581 eligible ICH patients were included in the final analysis. According to the results of the swallowing function assessment, patients were divided into 24 084 (73.9%) non-dysphagia group and 8497 (26.1%) dysphagia group. Compared with the non-dysphagia group, the dysphagia group had poor outcomes, including higher incidence of pneumonia (60.2% vs 17.3%, OR 4.82, 95% CI 4.53-5.13) and in-hospital mortality (3.5% vs 0.3%, OR 5.96, 95% CI 4.41-8.06), longer length of stay (P < .01), higher hospitalization cost (P < .01), and higher medicine cost (P < .01). In multivariable analysis, the incidence of dysphagia was independently associated with older age (OR 1.10, 95% CI 1.09-1.11), male sex (OR 1.13, 95% CI 1.06-1.20), arrival at the hospital by emergency medical services (OR 2.11, 95% CI 1.99-2.24), lower Glasgow Coma Scale (GCS) score (per point decrease) (OR 0.78, 95% CI 0.77-0.78), history of ICH (OR 1.25, 95% CI 1.17-1.35), and higher glucose level (OR 1.09, 95% CI 1.07-1.10).
Conclusions: More than one-quarter of acute ICH patients were diagnosed with dysphagia, which was associated with poor hospital outcomes. The early identification and management of dysphagia may reduce the possibility of stroke-associated pheumonia, shorten the length of hospital stay, and reduce medical cost.
目的：吞咽困难是急性卒中的一种常见且严重的症状；然而，很少有研究调查脑内出血（ICH）患者吞咽困难的发生率和风险因素。我们旨在确定急性 ICH 患者吞咽困难的发生率和风险因素，并评估其对住院治疗结果的影响：我们从中国卒中中心联盟（CSCA）收集了2015年8月至2019年7月的ICH患者数据，并进行了回顾性分析。进行单变量分析和多变量分析，以确定与吞咽困难和住院治疗结果相关的因素：32 581 名符合条件的 ICH 患者纳入最终分析。根据吞咽功能评估结果，患者被分为 24 084 例（73.9%）非吞咽困难组和 8497 例（26.1%）吞咽困难组。与非吞咽困难组相比，吞咽困难组的预后较差，包括肺炎发生率较高（60.2% vs 17.3%，OR 4.82，95% CI 4.53-5.13）、院内死亡率较高（3.5% vs 0.3%，OR 5.96，95% CI 4.41-8.06）、住院时间较长（P < .01）、住院费用较高（P < .01）、医药费用较高（P < .01）。在多变量分析中，吞咽困难的发生率与年龄较大（OR 1.10，95% CI 1.09-1.11）、性别为男性（OR 1.13，95% CI 1.06-1.20）、通过急诊服务到达医院（OR 2.11，95% CI 1.99-2.24）、格拉斯哥昏迷量表（GCS）评分较低（每降低一分）（OR 0.78，95% CI 0.77-0.78）、有 ICH 病史（OR 1.25，95% CI 1.17-1.35）和血糖水平较高（OR 1.09，95% CI 1.07-1.10）：超过四分之一的急性 ICH 患者被诊断为吞咽困难，这与不良的住院预后有关。早期发现和处理吞咽困难可减少卒中相关性肺炎的发生，缩短住院时间并降低医疗费用。
期刊介绍：
Launched in 1995, Alternative Therapies in Health and Medicine has a mission to promote the art and science of integrative medicine and a responsibility to improve public health. We strive to maintain the highest standards of ethical medical journalism independent of special interests that is timely, accurate, and a pleasure to read. We publish original, peer-reviewed scientific articles that provide health care providers with continuing education to promote health, prevent illness, and treat disease. Alternative Therapies in Health and Medicine was the first journal in this field to be indexed in the National Library of Medicine. In 2006, 2007, and 2008, ATHM had the highest impact factor ranking of any independently published peer-reviewed CAM journal in the United States—meaning that its research articles were cited more frequently than any other journal’s in the field.
Alternative Therapies in Health and Medicine does not endorse any particular system or method but promotes the evaluation and appropriate use of all effective therapeutic approaches. Each issue contains a variety of disciplined inquiry methods, from case reports to original scientific research to systematic reviews. The editors encourage the integration of evidence-based emerging therapies with conventional medical practices by licensed health care providers in a way that promotes a comprehensive approach to health care that is focused on wellness, prevention, and healing. Alternative Therapies in Health and Medicine hopes to inform all licensed health care practitioners about developments in fields other than their own and to foster an ongoing debate about the scientific, clinical, historical, legal, political, and cultural issues that affect all of health care.
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