A Comparative Study between the Three Waves of the Pandemic on the Prevalence of Oropharyngeal Dysphagia and Malnutrition among Hospitalized Patients with COVID-19

Abstract

Background: The phenotype of patients affected by COVID-19 disease changed between the waves of the pandemic. We assessed the prevalence of oropharyngeal dysphagia (OD), malnutrition (MN), and mortality between the first three waves of COVID-19 patients in a general hospital. Methods: a prospective observational study between April 2020–May 2021. Clinical assessment for OD was made with the volume-viscosity swallowing test; nutritional assessment was performed consistent with GLIM criteria. A multimodal intervention was implemented in the second and third wave, including (a) texturized diets—fork mashable (1900 kcal + 90 g protein) or pureed (1700 kcal + 75 g protein), (b) oral nutritional supplements (500–600 kcal + 25–30 g protein), and (c) fluid thickening (250 mPa·s or 800 mPa·s). Results: We included 205 patients (69.3 ± 17.6 years) in the 1st, 200 (66.4 ± 17.5 years) in the 2nd, and 200 (72.0 ± 16.3 years;) in the 3rd wave (p = 0.004). On admission, prevalence of OD was 51.7%, 31.3% and 35.1%, and MN, 45.9%, 36.8% and 34.7%, respectively; mortality was 10.7%, 13.6% and 19.1%. OD was independently associated with age, delirium, and MN; MN, with age, OD, diarrhea and ICU admission; mortality, with age, OD and MN. (4) Conclusions: Prevalence of OD, MN and mortality was very high among COVID-19 patients. OD was independently associated with MN and mortality. An early and proactive multimodal nutritional intervention improved patients’ nutritional status.

The Impact of Frailty, Oropharyngeal Dysphagia and Malnutrition on Mortality in Older Patients Hospitalized for Covid-19

“…In a previous study, with a younger cohort of patients from the first wave of the pandemic, we found an overall mortality rate of 16.6% over 6-month follow up [ 13 ]. Another study, with younger individuals, found an IH mortality of 10.7%, 13.6% and 19.1% over the first, second and third waves, respectively [ 14 ]. Several studies have shown widely divergent mortality rates: 34.0% (IH) in Canada [ 31 ], 11.0% in China [ 2 ], and 11.4%, 19.8% and 18.0% (IH) in Spain [ 32 - 34 ].…”

“…OD is not always assessed in COVID-19 and thus might have not been included in other studies on COVID-19 mortality. We previously found that OD was highly prevalent in the general COVID-19 population and significantly associated with MN, impaired functionality, institutionalization and intra-hospital and 6 months mortality [ 13 , 14 ], showing the relevance of OD assessment and treatment in these patients. Finally, a systematic review recommended strict preventive measures, timely diagnosis, and aggressive therapeutic and nontherapeutic care to improve COVID-19 frail patient outcomes [ 6 ].…”

“…The majority of them had severe (25.5%) or critical COVID-19 (46.9%). Our population age is higher than the majority of the published studies as we included only older patients of more than 70 years [ 13 , 14 ]. Overall length of hospital stay (14.0±11.2 days) was lower than a previous study we published on the first wave of the pandemic (16.8±13.0 days) [ 13 ] and of Chinese studies (14 days (IQR 10-19)) [ 35 ], but higher than that of another of our previous studies with patients from the first, second and third waves (12.7±10.9 days) [ 14 ] and to those reported in a systematic review which showed a mean 5 days (IQR 3-9).…”

“…It has been recommended to pay more attention to FR screening among COVID-19 patients to aid prognosis and decision-making [ 5 ]. In turn, oropharyngeal dysphagia (OD) is closely related to aging, impaired functionality, FR, COVID-19 and impaired outcomes such as malnutrition (MN) [ 13 , 14 ]. A study from a general hospital concluded that prevalence of OD (51.7%) and MN (45.5%; 10.1±5.0kg weight loss) in hospitalized patients with COVID-19 was very high [ 13 ].…”

“…OD was associated with greater 6-month mortality, was an independent risk factor for MN and independently associated with comorbidities, neurological symptoms, and poor functionality [ 13 ]. In a second study including COVID-19 patients from the first three waves of the pandemic, a high prevalence of OD and MN was confirmed and a change in the nutritional management of patients from the first to the second wave, with the early application of oral nutritional supplements (ONS), significantly improved clinical outcomes of COVID-19 patients [ 14 ].…”