Table 2.
Factors associated with recovery of dysphagia in patients with acute respiratory distress syndrome with oral endotracheal intubation
| Bivariable Analysis |
Multivariable Analysis |
|||
|---|---|---|---|---|
| Hazard Ratio* (95% CI) | P Value† | Hazard Ratio* (95% CI) | P Value† | |
| Demographics | ||||
| Age | 0.99 (0.96–1.01) | 0.221 | ||
| Male | 0.92 (0.54–1.57) | 0.757 | ||
| White | 0.86 (0.51–1.47) | 0.587 | ||
| Baseline health status before admission | ||||
| Charlson Comorbidity Index | 0.90 (0.82–1.00) | 0.045 | 0.94 (0.83–1.06) | 0.327 |
| Neurological disease‡ | 1.27 (0.79–2.02) | 0.325 | ||
| Upper gastrointestinal disease§ | 0.42 (0.22–0.83) | 0.012 | 0.54 (0.26–1.14) | 0.106 |
| Body mass index | ||||
| Normal (18.5–24.9 kg/m2) | Reference | |||
| Underweight (<18.5 kg/m2) | 0.80 (0.47–1.36) | 0.405 | ||
| Overweight (25–29.9 kg/m2) | 0.73 (0.38–1.41) | 0.344 | ||
| Obese (≥30 kg/m2) | 0.74 (0.37–1.50) | 0.408 | ||
| ICU admission diagnosis | ||||
| Respiratory (including pneumonia) | Reference | Reference | ||
| Nonpulmonary sepsis and infectious disease | 1.29 (0.72–2.31) | 0.399 | 0.90 (0.44–1.81) | 0.762 |
| Trauma | 2.23 (1.42–3.51) | 0.001 | 1.51 (0.89–2.59) | 0.130 |
| Other | 0.84 (0.41–1.69) | 0.620 | 1.01 (0.59–2.04) | 0.767 |
| ICU factors | ||||
| APACHE II score at ICU admission | 1.01 (0.99–1.04) | 0.330 | ||
| SOFA score at ARDS onset | 1.00 (0.95–1.07) | 0.902 | ||
| Maximum daily SOFA score | 0.98 (0.93–1.05) | 0.607 | ||
| Ever reintubated | 1.13 (0.71–1.79) | 0.604 | ||
| Intubation duration | 0.97 (0.94–1.01) | 0.208 | ||
| ICU length of stay | 0.96 (0.93–1.00) | 0.060 | 0.96 (0.93–1.00) | 0.047 |
| Hospital factors | ||||
| Time from extubation to hospital discharge | 0.99 (0.98–1.01) | 0.427 | ||
| Hospital length of stay | 0.99 (0.98–1.01) | 0.255 | ||
| MRC strength score at hospital discharge | 1.01 (0.97–1.05) | 0.664 | ||
| Ever hospital readmission before recovery | 1.38 (0.80–2.38) | 0.251 | ||
| SSQ | ||||
| SSQ score per 5 points at hospital discharge | 1.00 (0.99–1.01) | 0.684 | ||
Definition of abbreviations: APACHE II = Acute Physiology and Chronic Health Evaluation II; ARDS = acute respiratory distress syndrome; CI = confidence interval; ICU = intensive care unit; MRC = Medical Research Council; SOFA = Sequential Organ Failure Assessment; SSQ = Sydney Swallowing Questionnaire.
A hazard ratio less than 1 indicates a longer time to recovery from dysphagia. Findings from the multivariable regression analysis demonstrate a statistically significant hazard ratio of 0.96 for a 1-day increase in ICU length of stay, indicating a 4% increase in the probability of delayed recovery from dysphagia symptoms after hospital discharge for each additional 1-day increase in ICU length of stay.
P values calculated using Fine and Gray proportional subdistribution hazards regression models (31). Covariates were included in the multivariable model on the basis of a bivariable association of P < 0.20.
Includes stroke and any other neurological disease (e.g., transient ischemic attack, Parkinson disease, multiple sclerosis, dementia).
Includes peptic ulcer, hiatal hernia, and gastroesophageal reflux disease.