Incidence and predictors of delirium on the intensive care unit after acute myocardial infarction, insight from a retrospective registry

Abstract

Objectives: This study aimed to identify the incidence and potential risk factors for delirium after myocardial infarction (MI).Background: Delirium is a common complication on intensive care units. Data on incidence and especially on predictors of delirium in patients after acute MI are rare.Methods: In this retrospective study, all patients hospitalized for MI treated with coronary angiography in an university hospital in 2018 were included and analyzed.Onset of delirium within the first 5 days after MI was attributed to the MI and was defined by a Nursing Delirium screening scale (NuDesc) ≥2. This score is taken as part of daily care in every patient on intensive care unit three times a day by especially trained nurses.Results: A total of 624 patients with MI (age 68.5 ± 13.2 years, ST-elevation MI 41.6%, hospital mortality 3.2%) were included in the study. Delirium was detected in 10.9% of all patients. In the subgroup of patients with a stay on the intensive care unit (ICU) for more than 24 hr (n = 229), delirium was detected in 29.7%.Hospital and ICU stay were significantly longer in patients with delirium (p < .001). Delirium was an independent predictor of prolonged ICU-stay. Independent predictors of delirium were age, dementia, alcohol abuse, cardiac arrest, hypotension, and leucocytosis. Infarct size or presentation with ST-elevation were not associated with incidence of delirium. Conclusion:Development of delirium is frequent after acute MI and prolongs hospitalization. Incidence of delirium is associated with clinical instability, preexisting comorbidity, and age rather than MI type or size.

Incidence and predictors of delirium on the intensive care unit in patients with acute kidney injury, insight from a retrospective registry

“…We found delirium in 60.1% of patients with AKI. This is in concordance with the incidence of delirium reported in other ICU cohorts, ranging from 22 to 83% depending on assessment methods and population 14 , 15 , 23 , 24 . While the incidence was lower in AKI stage I (53.6%), the incidence increased in stage II (66.7%) and stage III (66.9%).…”

“…Most literature on delirium focuses on specific patient cohorts such as mechanically ventilated patients, elderly or surgical patients when investigating delirium 32 , 33 . In these patients, common predictors for delirium are age, shock, alcohol misuse, and mechanical ventilation 1 , 12 , 15 , 34 , 35 . We could confirm these independent predictors of delirium in patients with AKI.…”

“…Delirium is routinely assessed by specially trained nurses in all patients on the ICU at least three times a day using the NuDesc and the RASS (Richmond agitation and sedation scale) score as described before 14 , 15 . We established superusers, which introduced and trained the nurses in using the score.…”

“…To date, no study exists differentiating the association of delirium and the AKI stage. Defining this patients cohort might be of special interest, since incidence and predictors of delirium differ significantly in various patient collectives therefore hampering generalization 13 – 15 .…”

Delirium in Critically Ill Patients with and without COVID-19—A Retrospective Analysis

“…At first glance, these findings might seem counterintuitive since SARS-CoV-2 has neurotropic characteristics and might invade the central nervous system via the angiotensin converting enzyme 2 receptors expressed in the olfactory bulb, thereby causing neuroinflammation and ultimately delirium [ 29 ]. It is important, however, to consider that several other medical conditions like acute respiratory distress syndrome [ 27 ], cardiac arrest [ 30 ], and acute kidney injury [ 31 ] might also complicate the ICU course of COVID-19 patients. Our data suggest that known promoters of delirium including age, duration of ICU stay, dementia, alcohol abuse, and disease severity trigger delirium rather that SARS-CoV-2 infection.…”