Morbimortalidad asociada a la disfagia en pacientes ingresados en un hospital general universitario

RESUMEN Introducción: La disfagia tiene una morbimortalidad importante en pacientes hospitalizados. Objetivos: principal; describir las características de los pacientes con disfagia hospitalizados y, secundarios; cuantificar y analizar la prevalencia de mortalidad y de reingresos. Metodología: Estudio transversal descriptivo de las hospitalizaciones por disfagia durante el año 2015 en un Hospital General Universitario. Resultados: Se evaluaron 431 historias clínicas. La edad de los pacientes fue de 83,21 (DE 11,4) años, el 52,5% fueron mujeres y el 47,2% varones; la estancia media fue de 11,1 (DE 7,99) días. En el 71,2 % de los casos la disfagia fue por afectación de la fase orofaríngea. En el 80,51% de los casos se diagnosticaron complicaciones respiratorias: 48,12% neumonía aspirativa por líquidos, 40,05 % neumonitis química por aspiración y 11,81% neumonía aspirativa por sólidos. La mortalidad general asociada a las complicaciones respiratorias respecto del total de los casos de disfagia fue del 24,49%. El 50,48% de los pacientes con neumonía aspirativa fallecieron. La principal causa de la disfagia fue las enfermedades neurológicas (un 77,25%). La mortalidad fue significativamente mayor en las mujeres - 42,3% frente al 7,8% - (p < 0,01) y esta diferencia se mantuvo tras ajustar el resultado por edad: OR 9,937, IC95%: 5,446; 18,131. El 13,10% de los pacientes reingresaron al menos en una ocasión. Los pacientes de geriatría presentaron un mayor número de reingresos por número de ingresos. Discusión: las enfermedades neurológicas fueron la principal causa de disfagia. La mortalidad fue significativamente mayor en las mujeres.

ABSTRACT Introduction: Dysphagia is an important associated morbidity and mortality in hospitalized patient. Objectives: Main; to describe the characteristics of patients admitted for dysphagia and secondary; quantify and analyze the prevalence of mortality and readmissions. Methodology: Cross-sectional study descriptive revenues by dysphagia during the year 2015 in a University General Hospital. Results: 431 records were evaluated. The age of the patients was 83,21 (11.4), 52.5% women and 47.2% male; the average stay was 11.1 (7.99) days. In 71,2% of cases the dysphagia was involvement of the oropharyngeal phase. 80.51% of cases were diagnosed respiratory complications. The percentage distribution of these complications were: in 48.12% aspiration pneumonia due to fluids, in 40.05% chemical aspiration pneumonitis and in 11.81% aspiration pneumonia due to solids. The overall mortality associated with respiratory complications compared to the total of cases of dysphagia was 24.49%. 50.48% of patients diagnosed with aspiration pneumonia died. The main cause of dysphagia was neurological diseases (77.25%). Mortality was significantly higher in women - 42.3% of women compared with 7.8% of males - (p < 0.01) and this difference remained after adjusting the result by age: OR 9,937, 95% CI: 5,446; 18,131. 13.10% of patients re-entered at least on one occasion. Patients of geriatric unit that presented in greater number of readmissions by admissions. Discussion: neurological diseases were the main cause of dysphagia. Mortality was significantly higher in women

Functional capacity, bone mineral density and neoformation-resorption bone markers in patients under 18 years of age with reduced mobility. / Capacidad funcional, densidad mineral ósea y marcadores de neoformación-reabsorción ósea en pacientes menores de 18 años con movilidad reducida.

INTRODUCTION: Prolonged immobilization associated with several neurological disorders causes se condary osteoporosis with pathological fractures and persistent bone pain. OBJECTIVES: To establish the association between bone mineral density (BMD), neoformation and bone resorption markers and the degree of functional capacity in children under 18 years of age with reduced mobility. Pa tients and Method: Cross-sectional study conducted in Ciudad Real, Spain between January 1, 2016, and December 31, 2017 with patients aged between 6 and 18 years diagnosed with different neuro logical disorders. The following variables were analyzed: age, sex, pubertal stage, functional capacity according to the Functional Mobility Scale (FMS), which assesses the ability to walk from 5, 50 to 500 meters, BMD, 25-hydroxy-vitamin D, alkaline phosphatase and osteocalcin in blood, and N-terminal telopeptide crosslinks in collagen type I (NTX-I) in urine. BMD, alkaline phosphatase, osteocalcin, and NTX-I values are expressed in Z score according to reference values for age and sex. The Pear son and Spearman correlations were used for data analysis. RESULTS: 36 patients (52.7% girls) with an average age of 8.6±4.7 years. Mean FMS value: 5.3 out of 18. Mean BMD: -1.99 ± 1.7 standard deviations (SD), mean alkaline phosphatase: -2.64 ± 1.08, mean osteocalcin: -2.15 ± 1.39, and mean NTX-I: +3 ± 1.72. There was a significant association between BMD and FMS for 5 meters (r = 0.395; p = 0.017) and for total score (r = 0.365; p = 0.029). There were no significant differences according to the stages of pubertal development. CONCLUSIONS: In this population, there was a decrease in BMD and bone neoformation markers, and an increase of bone resorption markers with no association with pubertal development. Patients with a lower degree of mobility present a lower BMD.

Capacidad funcional, densidad mineral ósea y marcadores de neoformación-reabsorción ósea en pacientes menores de 18 años con movilidad reducida / Functional capacity, bone mineral density and neoformation-resorption bone markers in patients under 18 years of age with reduced mobility

Resumen: Introducción: La inmovilización prolongada asociada a diversas enfermedades neurológicas, causa osteoporosis secundaria con fracturas patológicas y dolor óseo persistente. Objetivos: Establecer la asociación entre densidad mineral ósea (DMO), marcadores de neoformación y reabsorción ósea y grado de capacidad funcional en pacientes menores de 18 años con movilidad reducida. Pacientes y Método: Estudio transversal, realizado entre 1/1/2016 y 31/12/2017 en pacientes de 6 a 18 años diagnosticados de distintas enfermedades neurológicas en Ciudad Real (España). Se analizaron las variables biodemográficas, capacidad funcional según la Functional Mobility Scale (FMS), que valora la movilidad en 5, 50 y 500 metros, DMO, 25-hidroxi-vitamina D, fosfatasa alcalina, osteocalcina en sangre y telopéptido amino terminal de cadena cruzada de colágeno tipo I en orina (NTX-I). Se expresan DMO, fosfatasa alcalina, osteocalcina y NTX-I en Z score según valores de referencia para edad y sexo. Se utilizaron estadísticas descriptivas y correlaciones de Pearson y Spearman. Resulta dos: 36 pacientes (52,7% niñas), edad media de 8,6 ± 4,7 años. Valor medio de FMS: 5,3 sobre 18. DMO media: -1,99 ± 1,7 desviaciones estándar (DE), fosfatasa alcalina media: -2,64 ± 1,08, osteocalcina media: -2,15 ± 1,39, y NTX-I medio: +3 ± 1,72. Hubo asociación significativa entre DMO y FMS para 5 metros (r = 0,395; p = 0,017) y para la puntuación total (r = 0,365; p = 0,029). No se encon traron diferencias significativas según estadios de desarrollo puberal. Conclusiones: En la población estudiada se observa disminución en la DMO y en marcadores de neoformación ósea y elevación de marcadores de reabsorción ósea sin asociación con el desarrollo puberal. Los pacientes con menor grado de movilidad presentan una DMO inferior.

Abstract: Introduction: Prolonged immobilization associated with several neurological disorders causes se condary osteoporosis with pathological fractures and persistent bone pain. Objectives: To establish the association between bone mineral density (BMD), neoformation and bone resorption markers and the degree of functional capacity in children under 18 years of age with reduced mobility. Pa tients and Method: Cross-sectional study conducted in Ciudad Real, Spain between January 1, 2016, and December 31, 2017 with patients aged between 6 and 18 years diagnosed with different neurological disorders. The following variables were analyzed: age, sex, pubertal stage, functional capacity according to the Functional Mobility Scale (FMS), which assesses the ability to walk from 5, 50 to 500 meters, BMD, 25-hydroxy-vitamin D, alkaline phosphatase and osteocalcin in blood, and N-terminal telopeptide crosslinks in collagen type I (NTX-I) in urine. BMD, alkaline phosphatase, osteocalcin, and NTX-I values are expressed in Z score according to reference values for age and sex. The Pear son and Spearman correlations were used for data analysis. Results: 36 patients (52.7% girls) with an average age of 8.6±4.7 years. Mean FMS value: 5.3 out of 18. Mean BMD: -1.99 ± 1.7 standard deviations (SD), mean alkaline phosphatase: -2.64 ± 1.08, mean osteocalcin: -2.15 ± 1.39, and mean NTX-I: +3 ± 1.72. There was a significant association between BMD and FMS for 5 meters (r = 0.395; p = 0.017) and for total score (r = 0.365; p = 0.029). There were no significant differences according to the stages of pubertal development. Conclusions: In this population, there was a decrease in BMD and bone neoformation markers, and an increase of bone resorption markers with no association with pubertal development. Patients with a lower degree of mobility present a lower BMD.