Impact of Inflammation and Muscle Mass on Prognosis in Hospitalized Patients with Suspected Dysphagia at a Tertiary...

Background/Objectives: Dysphagia is associated with an increased risk of in-hospital complications and adverse outcomes. Prognosis in frail hospitalized populations is influenced by systemic inflammation and reduced muscle mass. Calf circumference (CC) and an estimated appendicular skeletal muscle index (ASMI) can serve as indirect measures of muscle mass, while inflammatory status may be captured by C-reactive protein (CRP), albumin, and the CRP/albumin ratio. This study aimed to evaluate the prognostic value of indirect biomarkers of inflammation and muscle mass to predict prognosis in hospitalized patients with suspected dysphagia. Methods: A retrospective observational study was conducted at a tertiary hospital and included patients admitted with suspected dysphagia between April 2015 and October 2024. On admission, demographic variables (sex and age), anthropometry (weight, height, and CC), EAT-10 (Eating Assessment Tool) score, and serum laboratory parameters (CRP, albumin) were collected. ASMI was estimated using the formula -10.427 + (CC × 0.768) - (age × 0.029) + (sex × 7.523)/(height²). Outcomes were in-hospital mortality and length of hospital stay. Comparisons were performed between survivors and non-survivors, and multivariable models adjusted for age and sex were used to identify independent associations with mortality. Results: A total of 4241 patients were included (51.2% women), with a median age of 85 (Interquartile range [IQR] 14) years and a mean EAT-10 score of 15.98 (SD 7.79). In-hospital mortality was 18.13% (n = 769). Non-survivors were older (86 [IQR 11] vs. 84 [IQR 14] years; p < 0.001) and displayed a more inflammatory profile, with higher CRP (78.1 [IQR 114.28] vs. 44 [IQR 96] mg/L) and CRP/albumin ratio (27.27 [IQR 43.04] vs. 13.64 [IQR 31.77]; p < 0.001), and lower albumin (3 [IQR 0.8] vs. 3.3 [IQR 0.8] g/dL; p < 0.001). They also had lower muscle mass, with reduced CC and lower ASMI in both sexes. In multivariable analysis, a higher CRP/albumin ratio was independently associated with increased odds of death (OR 1.011; 95% CI 1.008-1.014; p < 0.001), whereas a higher ASMI was protective (OR 0.885; 95% CI 0.801-0.978; p = 0.017). Higher CRP/albumin ratios were also associated with longer hospital stays and lower albumin, CC, and ASMI values. Conclusions: In hospitalized patients with suspected dysphagia, systemic inflammation and lower muscle mass were associated with worse clinical outcomes. The CRP/albumin ratio independently predicted higher in-hospital mortality and prolonged hospitalization, whereas higher estimated ASMI was associated with lower mortality risk, supporting the combined prognostic value of inflammatory and muscle-mass indicators in this population.