Predisposing Risk Factors for Delirium in Living Donor Liver Transplantation Patients in Intensive Care Units

Wang, Szu-Han; Wang, Jiun‐Yi; Lin, Ping‐Yi; Lin, Kuo‐Hua; Ko, Chih‐Jan; Hsieh, Chia-En; Lin, Hui-Chuan; Chen, Yao‐Li

doi:10.1371/journal.pone.0096676

Cited by 33 publications

(61 citation statements)

References 22 publications

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“…The total incidence of delirium was 37% in the present study. This incidence is generally consistent with the incidences reported in previous studies [ 22 , 24 , 26 ].…”

Section: Discussionsupporting

confidence: 92%

Risk Factors of Delirium in Sequential Sedation Patients in Intensive Care Units

Yang

Zhou

Kang

et al. 2017

BioMed Research International

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Background Delirium is a primary adverse event in ventilated patients who receive long-term monosedative treatment. Sequential sedation may reduce these adverse effects. This study evaluated risk factors for delirium in sequential sedation patients. Methods A total of 141 patients who underwent sequential sedation were enrolled. Delirium was diagnosed using Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) scale. Univariate and multivariate Cox proportional hazards regressions were used to predict risk factors. Results Older age (≥51) (RR = 2.432, 95% CL 1.316–4.494, p = 0.005), higher SOFA score (≥14) (RR = 2.022, 95% CL 1.076–3.798, p = 0.029), regular smoking (RR = 2.366, 95% CL 1.277–4.382, p = 0.006), and higher maintenance dose of midazolam (RR = 1.052, 95% CL 1.000–1.107, p = 0.049) and fentanyl (RR = 1.045, 95% CL 1.019–1.072, p = 0.001) when patients met sequential criteria, were independent risk factors of delirium. Sequential sedation with dexmedetomidine (RR = 0.448, 95% CL 0.209–0.963, p = 0.040) was associated with a lower risk of delirium. Conclusions Older age, higher SOFA score, regular smoking, and higher maintenance dose of midazolam and fentanyl when patients met sequential criteria were independent risk factors of delirium in sequential sedation patients. Sequential sedation with dexmedetomidine reduced risk of delirium.

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“…The total incidence of delirium was 37% in the present study. This incidence is generally consistent with the incidences reported in previous studies [ 22 , 24 , 26 ].…”

Section: Discussionsupporting

confidence: 92%

Risk Factors of Delirium in Sequential Sedation Patients in Intensive Care Units

Yang

Zhou

Kang

et al. 2017

BioMed Research International

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“…To test this hypothesis, further basic and clinical research is 101 necessary. A low serum Na level has also been associated with the incidence of delirium in a few reports [22][23][24] . In this study, the serum Na levels on POD 3 were significantly lower in the high-risk group compared to the low-risk group.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Postoperative Delirium in Abdominal Surgery: A Proposal of a Postoperative Delirium Risk Score in Abdominal Surgery

Miyagawa

Yokoyama²,

Fukuzawa³

et al. 2016

Dig Surg

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Background/Aims: Despite the presence of several diagnosis scales for delirium, no prediction scale that is specific for postoperative delirium after abdominal surgery is available. We sought to create a novel delirium prediction system that is specific for abdominal surgery. Methods: This study included 213 consecutive patients who required management in the surgical ICU following abdominal surgery. The Neelon and Champagne (NEECHAM) Confusion score was monitored throughout the postoperative course and patients with low NEECHAM score (≤26) were diagnosed as having delirium. Results: Seventy-three patients (34%) were categorized in the delirium group. Multivariate analyses indicated that an age >70 years, hypertension, those undergoing hepatopancreatobiliary or upper gastrointestinal surgeries, a serum albumin level <2.5 g/dl on postoperative day (POD) 3 or 5 and a ≥6 mEq/l gap in the serum sodium level between the preoperative value and that on POD 3 were independently associated with a low NEECHAM score (≤26). When the presence of each risk was counted as 1 point, 21 patients had ≥4 points and 15 of them (71%) had low NEECHAM score. Conclusion: The scoring system combining multiple risk factors may be useful for predicting patients with an elevated risk for postoperative delirium after abdominal surgery.

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“…It has been suggested that pathogenesis of POD presenting after LT is multifactorial: infections, organ failure, encephalopathy and neurotoxicity of immunosuppressants have all been called into question. Reported POD incidence in LT patients ranges from 10 to 47% [10][11][12][13][14][15][16]. Also in the setting of LT, POD has been associated with prolonged hospital and ICU stay, and increased mortality.…”

Section: Introductionmentioning

confidence: 99%

Graft factors as determinants of postoperative delirium after liver transplantation

et al. 2020

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Post-operative delirium (POD) is a frequent complication after surgery, occurring in 15–20% of patients. POD is associated with a higher complications rate and mortality. Literature on POD after liver transplantation (LT) is limited, with the few available studies reporting an incidence of 10–47%. The aim of this study was analyzing pattern, risk factors and clinical impact of POD after LT. Data on donor and recipient characteristics, postoperative course and POD of consecutive adult LT recipients from March 2016 to May 2018 were prospectively collected and retrospectively analyzed. Risk factors for POD were analyzed using univariable logistic regression and Lasso regression. Kaplan–Meier method was used for survival analysis. 309 patients underwent LT during study period; 3 were excluded due to perioperative death. Incidence of POD was 13.4% (n = 41). The median day of onset was 5th (IQR [4–7]) with a median duration of 4 days (IQR [3–7]). Several risk factors, related to the severity of liver disease and graft characteristics, were identified. Graft macrovesicular steatosis was the only factor independently associated with POD at multivariable analysis (OR 1.27, CI 1.09–1.51, p = 0.003). POD was associated with a higher rate of severe postoperative complications and longer intensive care unit and hospital stay, but did not significantly impact on patient and graft survival. Incidence of POD after LT is comparable to that observed after general surgery and graft factors are strongly associated with its onset. These results help identifying a subset of patients to be considered for preventive interventions.

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Predisposing Risk Factors for Delirium in Living Donor Liver Transplantation Patients in Intensive Care Units

Cited by 33 publications

References 22 publications

Risk Factors of Delirium in Sequential Sedation Patients in Intensive Care Units

Risk Factors of Delirium in Sequential Sedation Patients in Intensive Care Units

Risk Factors for Postoperative Delirium in Abdominal Surgery: A Proposal of a Postoperative Delirium Risk Score in Abdominal Surgery

Graft factors as determinants of postoperative delirium after liver transplantation

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