Delirium symptoms during hospitalization predict long-term mortality in patients with severe pneumonia

Aliberti, Stefano; Bellelli, Giuseppe; Belotti, Mauro; Morandi, Alessandro; Messinesi, Grazia; Annoni, Giorgio; Pesci, Alberto

doi:10.1007/s40520-014-0297-9

Cited by 30 publications

(20 citation statements)

References 25 publications

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“…Although delirium has frequently been associated with mortality in geriatric and other critical care samples, 23 our is the first to demonstrate an association between delirium and subsequent mortality. Of note, although previous studies have generally suggested that delirium is associated with worse 6-month 24 and 12-month mortality, 25 our findings suggest that the association between NSE (which was primarily delirium) and posttransplant mortality increased over time, rising to its greatest magnitude approximately 2 years postoperatively. Although the reasons behind the timing of this association are unclear, it is possible that impaired cognition, which is one of the primary long-term effects of severe delirium, leading to nonadherence with medical regimen or to more debilitated state, could explain this association.…”

Section: Discussioncontrasting

confidence: 59%

Neurological Sequelae and Clinical Outcomes After Lung Transplantation

Smith

Stonerock

Ingle

et al. 2018

Transplantation Direct

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BackgroundNeurological complications are common after lung transplantation. However, no large cohort studies have examined the incidence, predictors, and clinical significance of neurological events sustained by lung transplant recipients.MethodsWe conducted a retrospective cohort analysis of a consecutive series of lung transplant recipients, transplanted at Duke University Medical Center between May 2014 and February 2017 (n = 276). Early neurological complications (ie, occurring during the first week after transplant) were documented by transplant mental health specialists and included delirium, ischemic injury, and posterior reversible encephalopathy syndrome. Analyses accounted for age, native disease, sex, type of transplant, lung allocation score, and primary graft dysfunction. The objectives of the study were to characterize the prevalence and predictors of early neurological sequelae (NSE), occurring during the first week posttransplant, and the association between NSE and subsequent clinical outcomes, including length of stay and mortality.ResultsNeurological sequelae were common, occurring in 123 (45%) patients. Fifty-seven patients died over a follow-up interval of 2.1 years. The most common NSE were postoperative delirium (n = 110 [40%]) and posterior reversible encephalopathy syndrome (n = 12 [4%]), followed by stroke/transient ischemic attack and neurotoxicity. Higher lung allocation score was the strongest predictor of delirium. The presence of a NSE was associated with longer length of hospital stay (32 days vs 17 days, P < 0.001) and greater mortality (hazard ratio, 1.90; 95% confidence interval, 1.09-3.32], P = 0.024), with the greatest mortality risk occurring approximately 2 years after transplantation.ConclusionsNeurological events are relatively common after lung transplantation and associated with adverse clinical outcomes.

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Section: Discussioncontrasting

confidence: 59%

Neurological Sequelae and Clinical Outcomes After Lung Transplantation

Smith

Stonerock

Ingle

et al. 2018

Transplantation Direct

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“…Unlike other studies [38,39], there was no significant difference in mechanical ventilation time between delirium and non-delirium patients of pulmonary diseases. The most probable answer for this might be that the patients with pulmonary diseases which our studied included were patients with respiratory failure were ineffective in medical treatment, and the other reason could take for considered is the fact that we had a rather small number of patients with delirium who were documented and analyzed.…”

Section: Discussioncontrasting

confidence: 92%

ICU delirium:what is different between the type of diseases?

Feng

Yu-hang

et al. 2020

Preprint

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Background: Delirium is an acute neurological disorder that is quite common complication in intensive care unit (ICU) patients. However, there are no studies to focus on risk factors vary from disease to disease. The purpose of our study was to identify the risk factors and prognosis of delirium in patients with different disease types. Method: We conducted an observed study of consecutive patients from September to November 2016, who underwent surgical operation or with poor conservative treatment were admitted to the ICU. The patients were screened for delirium by using the diagnostic tools of Richmond Agitation Sedation Scale (RASS score) and the Confusion Assessment Method ICU (CAM-ICU). Results: A total of 406 patients met the inclusion criteria in our study. The overall incidence of ICU delirium was 45.8% (186/406), the delirium was highest in patients with brain disease (68%), followed by pulmonary disease (63%) and sepsis/shock (49%). The risk factors are different for different types of disease, for heart and vascular disease subgroup, only sleep quality (OR=0.236, p＜0.001) was independent risk factor for delirium. For abdominal disease subgroup, age (OR=2.514, p=0.002), vasoactive drugs (OR=13.799, p=0.002), and sleep quality (OR=0.114, p＜0.001) were risk factors for the delirium. And for sepsis and septic shock subgroup, age(OR=1.100, p=0.022), APACHE II scores(OR=1.255, p＜0.001) and sleep quality (OR=0.090, p=0.034) were risk factors for the delirium. ICU delirium is associated with worse outcomes including ICU stays(P<0.001) and 28-day mortality(P=0.001). The difference of ICU stays between delirium and non-delirium groups in the subgroup of heart and vascular disease(P<0.001), pulmonary disease(P=0.011), sepsis/septic shock(P<0.001) and cerebral disease(P=0.011) were consistent with the general population. But subgroup of sepsis/septic shock was the only one whom has the significant difference in the 28-day mortality (P=0.006) between delirium and non-delirium groups. Conclusion: The incidence and risk factors of delirium varied greatly with the type of disease. Age and sleep quality were independent risk factors for the development of delirium in most subgroup diseases. The prognosis of delirium was different in different disease types, among them, patients with sepsis/septic shock associated delirium have the worst prognosis.

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“…( 11 , 13 , 22 , 23 ) In fact, an association between age and delirium has often been described, thereby establishing delirium as a frequent complication in older ICU patients. ( 2 , 11 , 13 , 24 - 26 ) An independent association between delirium and long-term mortality has been detected in critically ill patients and in those with severe pneumonia, ( 25 , 27 - 29 ) but a counterfactual analysis showed that delirium prolongs the ICU stay but does not cause death in critically ill patients. ( 9 ) Thus, the relationship between delirium and mortality remains unclear.…”

Section: Discussionmentioning

confidence: 99%

Assessment of delirium using the PRE-DELIRIC model in an intensive care unit in Argentina

Sosa¹,

Roberti²,

Franco³

et al. 2018

Revista Brasileira De Terapia Intensiva

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ObjectiveTo describe the incidence of and risk factors for delirium in the intensive care unit of a tertiary care teaching hospital in Argentina and to conduct the first non-European study exploring the performance of the PREdiction of DELIRium in ICu patients (PRE-DELIRIC) model.MethodsProspective observational study in a 20-bed intensive care unit of a tertiary care teaching hospital in Buenos Aires, Argentina. The PRE-DELIRIC model was applied to 178 consecutive patients within 24 hours of admission to the intensive care unit; delirium was assessed with the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU).ResultsThe mean age was 64.3 ± 17.9 years. The median time of stay in the intensive care unit was 6 (range, 2 - 56) days. Of the total number of patients, 49/178 (27.5%) developed delirium, defined as a positive CAM-ICU assessment, during their stay in the intensive care unit. Patients in the delirium group were significantly older and had a significantly higher Acute Physiological and Chronic Health Evaluation II (APACHE II) score. The mortality rate in the intensive care unit was 14.6%; no significant difference was observed between the two groups. Predictive factors for the development of delirium were increased age, prolonged intensive care unit stay, and opioid use. The area under the curve for the PRE-DELIRIC model was 0.83 (95%CI; 0.77 - 0.90).ConclusionsThe observed incidence of delirium highlights the importance of this problem in the intensive care unit setting. In this first study conducted outside Europe, PRE-DELIRIC accurately predicted the development of delirium.

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Delirium symptoms during hospitalization predict long-term mortality in patients with severe pneumonia

Abstract: Delirium symptoms are independent predictors of one-year mortality in hospitalized patients with severe pneumonia. Further studies should confirm our results using prospective methods of collecting data.

Cited by 30 publications

References 25 publications

Neurological Sequelae and Clinical Outcomes After Lung Transplantation

Neurological Sequelae and Clinical Outcomes After Lung Transplantation

ICU delirium:what is different between the type of diseases?

Assessment of delirium using the PRE-DELIRIC model in an intensive care unit in Argentina

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