Admission systemic inflammation predicts swallowing decline in older adults with pulmonary tuberculosis

Tuberculosis remains a serious infectious disease worldwide. However, the status of swallowing function in older adults with pulmonary tuberculosis and the impact of systemic inflammation on swallowing decline during hospitalization have not been fully elucidated. We aimed to examine whether systemic inflammation at admission affects swallowing function decline in older patients with pulmonary tuberculosis.

This was a single-center, retrospective observational study. The inclusion criteria were patients aged ≥65 years with pulmonary tuberculosis who were admitted to a tuberculosis medical institution between April 2021, and November 2022. Systemic inflammation on admission was assessed with the modified Glasgow Prognostic Score (mGPS). The primary outcome was a decline in swallowing function during hospitalization, defined by a decrease in the Functional Oral Intake Scale (FOIS) score. All data, including mGPS and FOIS, were obtained from medical records. Patients were categorized into a "maintenance" group and a "decline" group based on changes in FOIS. Differences in FOIS scores across mGPS categories were also examined. Logistic regression analyses were performed to identify whether systemic inflammation at admission was an independent risk factor for swallowing decline. Model 1 was adjusted for age, BMI, miliary tuberculosis, and SARC-F ≥4; Model 2 was adjusted for age, miliary tuberculosis, and malnutrition.

A total of 119 patients were included in the analysis. During hospitalization, 31 patients (26.1 %) experienced a decline in swallowing function. Compared with the maintenance group, the decline group was significantly older and showed higher mGPS scores, lower serum albumin, lower Geriatric Nutritional Risk Index values, smaller calf circumference, lower walking ability, and lower FOIS scores at discharge. FOIS scores at both admission and discharge significantly differed across mGPS categories (p < 0.01). The prevalence of dysphagia, defined as FOIS ≤5, was 12.6 % (n = 15) at admission and 19.3 % (n = 23) at discharge. Logistic regression analysis revealed that higher mGPS at admission was independently associated with swallowing decline during hospitalization in both Model 1 (odds ratio 2.81, 95 % confidence interval 1.28-7.83) and Model 2 (odds ratio 2.77, 95 % confidence interval 1.23-7.71).

Systemic inflammation at admission was associated with the development of dysphagia during hospitalization among older adults with pulmonary tuberculosis. Moreover, the prevalence of dysphagia increased from 12.6 % at admission to 19.3 % at discharge.