Phase angle and overhydration are associated with post‐extubating dysphagia in patients with COVID‐19 discharged from the ICU

Abstract

Background: Few studies have evaluated the prevalence of post-extubation dysphagia and associated factors in patients with coronavirus disease 2019 . Our study assessed the prevalence of post-extubation dysphagia and body composition in patients with COVID-19 discharged from an intensive care unit (ICU).Methods: A prospective cohort study was performed in post-ICU extubated patients with acute respiratory distress syndrome related to COVID-19 in two referral hospitals. A total of 112 patients were evaluated and included; swallowing assessment and bioelectrical impedance analysis (BIA) were performed after extubation and discharge from the ICU. To identify associations between dysphagia, lower phase angle (PhA) (<4.8 • ) and hydration (extracellular water/total body water < 0.390) logistic and linear regression analyses were conducted. Results:The incidence of post-extubation dysphagia was 41% (n = 46). From these, 65% (n = 30) had severe swallowing impairment. Overhydration and PhA were significantly different in patients with dysphagia, and segmental hydration in the trunk and legs was higher than in arms. PhA <4.8 • (odds ratio [OR], 12.2; 95% CI, 4.3-34.1; P < .05) and overhydration measured by BIA (OR, 9.1; 95% CI, 3.4-24.5; P < .05) were associated with post-extubation dysphagia in multivariate analysis. PhA (<4.8 • ) was associated with a lower rate of swallowing recovery at hospital discharge (log-rank test = 0.007). Conclusions: A high incidence of post-extubation dysphagia was found in patients with COVID-19. Low PhA and overhydration were associated with the presence of dysphagia. Lower PhA was an independent factor for swallowing recovery at discharge.

Association between phase angle and adverse clinical outcomes in hospitalized patients with COVID‐19: A systematic review

“…The highest OR obtained was 12.2 (95% CI, 4.3–34.1; P < 0.05) for the analysis of the association between PhA < 4.8° and postextubation dysphagia after adjustment for sex and age in the study 26 conducted with 112 patients. Regarding HR, the highest value presented was 3.912 (95% CI, 1.322–34.1; P < 0.05) in a prospective study with 127 patients, which evaluated the association between PhA and mortality risk during 90 days, in a model adjusted for sex, age, body mass index (BMI), comorbidities, and hydration status 27 .…”

“…After reading titles and abstracts, 218 articles were excluded. This resulted in 11 articles to be read in full and, of these, only 7 met the eligibility criteria 22–28 …”

“…The countries of origin were mostly European: two were conducted in the Netherlands, 22,23 one in Switzerland, 25 one in Italy, 28 and one in Spain 27 . Two other studies were carried out in Mexico 24,26 (Table 2). Only one study presented the population sample from more than one referral center 26 and only two articles mentioned the use of the sample size calculation 24,27 …”

“…Regarding the age of the study participants, the mean and median >60 years prevailed. The lowest mean age observed was 54 ± 12 years in a study conducted in Mexico, which aimed to assess body composition and the presence of postextubation dysphagia 26 . The highest median age recorded was 69 years (59–80) in the study conducted in Spain, whose objective was to determine the predictive value of PhA in the 90‐day survival 27 .…”

“…In this systematic review, seven studies that investigated the association between PhA and adverse clinical outcomes of COVID‐19 were evaluated. The results of five studies 22–24,26,27 demonstrated that lower PhA values were associated with worsening of the clinical condition of these patients, evidencing its potential as a predictor of adverse clinical outcomes. Similarly, the literature has shown that PhA can be used as a prognostic parameter in several clinical situations such as cancer, 15,17,29 heart failure, 30,31 kidney disease, 32,33 and HIV infection 34,35 …”