From the Department of Medicine, Division of Digestive Diseases, Emory University School of Medicine, Atlanta, Georgia.
South Med J. 2021 Nov;114(11):692-696. doi: 10.14423/SMJ.0000000000001315.
Dysphagia is a common symptom in patients hospitalized with human immunodeficiency virus (HIV). There are limited data on the relation between dysphagia and important hospital outcomes. The aim of our study was to assess the impact of dysphagia on hospital costs, length of stay (LOS), mortality, and 30-day readmission rates in HIV patients hospitalized with dysphagia.
We used the Nationwide Readmissions Database to identify all adult hospitalizations with HIV between January 2010 and September 2015. We stratified cases according to the presence of dysphagia ( code 787.2) as a primary or secondary diagnosis, and compared clinical and hospital characteristics between the two groups. Multivariable regression models were used to compare LOS, total hospital costs, in-hospital mortality, 30-day mortality, and 30-day readmission rates between the two groups.
A total of 206,332 hospitalized patients with HIV were included in the study. Of these, 8699 (4.2%) patients had dysphagia. Patients with dysphagia were more likely to have Candida esophagitis (26.8% vs 3.6%), esophageal strictures (3.1% vs 0.2%), and malnutrition (41.6% vs 17.6%); and they were more likely to undergo upper endoscopy (23.2% vs 3.8%) and percutaneous feeding tube placement (9.2% vs 0.7%), all < 0.0001. On multivariate analysis, dysphagia was associated with longer LOS (12 vs 7.4 days; < 0.0001), higher hospitalization cost ($32,993 vs $21,813, < 0.0001), and increased 30-day readmissions (24% vs 20.8%, adjusted odds ratio 1.19; 95% confidence interval 1.12-1.25; < 0.0001). Patients with dysphagia had higher in-hospital mortality (4.7% vs 3.5%) but this did not reach statistical significance (adjusted odds ratio 1.01; 95% confidence interval 0.91-1.12; = 0.86).
In hospitalized patients with HIV, dysphagia is a significant independent predictor of longer LOS, higher costs, and higher rates of 30-day readmissions. These findings highlight the importance of optimizing treatment of dysphagia in patients with HIV to mitigate its negative impact on patient and hospital outcomes.
吞咽困难是人类免疫缺陷病毒（HIV）住院患者的常见症状。吞咽困难与重要的医院结局之间的关系数据有限。本研究的目的是评估吞咽困难对 HIV 住院患者的医院费用、住院时间（LOS）、死亡率和 30 天再入院率的影响。
我们使用全国再入院数据库，确定 2010 年 1 月至 2015 年 9 月期间所有成人 HIV 住院患者。我们根据吞咽困难（代码 787.2）是否为主要或次要诊断对病例进行分层，并比较两组之间的临床和医院特征。使用多变量回归模型比较两组之间的 LOS、总住院费用、院内死亡率、30 天死亡率和 30 天再入院率。
共纳入 206332 例 HIV 住院患者，其中 8699 例（4.2%）患者存在吞咽困难。吞咽困难患者更有可能患有念珠菌性食管炎（26.8% vs 3.6%）、食管狭窄（3.1% vs 0.2%）和营养不良（41.6% vs 17.6%）；他们更有可能接受上内窥镜检查（23.2% vs 3.8%）和经皮喂养管放置（9.2% vs 0.7%），所有差异均＜0.0001。多变量分析显示，吞咽困难与 LOS 延长（12 天 vs 7.4 天；＜0.0001）、住院费用增加（32993 美元 vs 21813 美元；＜0.0001）和 30 天再入院率增加（24% vs 20.8%，调整后比值比 1.19；95%置信区间 1.12-1.25；＜0.0001）相关。吞咽困难患者院内死亡率较高（4.7% vs 3.5%），但差异无统计学意义（调整后比值比 1.01；95%置信区间 0.91-1.12；=0.86）。
在 HIV 住院患者中，吞咽困难是 LOS 延长、费用增加和 30 天再入院率增加的显著独立预测因素。这些发现强调了优化 HIV 患者吞咽困难治疗的重要性，以减轻其对患者和医院结局的负面影响。
