Prognostic Value of Delirium in Patients With Acute Heart Failure in the Intensive Care Unit

Iwata, Eriko; Kondo, Toru; Kato, Toshiaki; Okumura, Takahiro; Nishiyama, Itsumure; Kazama, S.; Ishihara, T; Kondo, Sayano; Hiraiwa, Hiroaki; Tsuda, Toshihide; Ito, Michiho; Aoyama, Morihiko; Tanimura, Daisuke; Awaji, Yoshifumi; Unno, Kazumasa; Murohara, Toyoaki

doi:10.1016/j.cjca.2020.01.006

Cited by 11 publications

(19 citation statements)

References 34 publications

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“…Reduced EF causes a reduction in the blood supply to body tissues and organs, which in turn triggers edema and pulmonary stasis due to nutritional deficiencies (43), leading to heart failure. Iwata et al (44) showed that the degree of delirium correlates with the severity of heart failure, and the development of delirium during hospitalization was associated with short-term and long-term mortality in patients, although this can be predicted by the degree of heart failure. Cerebral perfusion is dependent on cardiac output, arterial pulsation intensity, cerebral artery patency, cerebral autoregulation, cerebellar vascular patency, and venous patency.…”

Section: Discussionmentioning

confidence: 99%

Construction and Application of a Model for Predicting the Risk of Delirium in Postoperative Patients With Type a Aortic Dissection

Ling²,

Chen³

2021

Front. Surg.

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Background: Postoperative delirium (POD), an alteration in a patient's consciousness pattern, can affect the treatment and prognosis of a disease.Objective: To construct a prediction model for delirium in patients with type A aortic dissection after surgery and to validate its effectiveness.Methods: A retrospective cohort design was used to study 438 patients undergoing surgical treatment for type A aortic dissection from April 2019 to June 2020 in tertiary care hospitals. POD (n = 78) and non-delirium groups (n = 360) were compared and analyzed for each index in the perioperative period. A prediction model was established using multifactorial logistic regression, and 30 patients' perioperative data were collected for model validation.Results: Eight predictors were included in this study: smoking, diabetes, previous cardiovascular surgery, ejection fraction (EF), time to aortic block, acute kidney injury, low cardiac output syndrome, and pulmonary complications. The area under the receiver operating characteristic (ROC) curve of the constructed prediction model was 0.98 ± 0.005, and the Youden index was 0.91. The validation results showed 97% sensitivity, 100% specificity, and 93% accuracy. The expression of the model was Z = Smoking assignment* – 2.807 – 6.009*Diabetes assignment – 2.994*Previous cardiovascular surgery assignment – 0.129*Ejection fraction assignment + 0.071*Brain perfusion time assignment – 2.583*Acute kidney injury assignment – 2.916*Low cardiac output syndrome assignment – 3.461*Pulmonary related complications assignment + 20.576.Conclusion: The construction of an effective prediction model for the risk of delirium in patients after type A aortic stratification can help identify patients at high risk of POD early. It also provides a reference for healthcare professionals in the prevention and care of these patients.

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Section: Discussionmentioning

confidence: 99%

Construction and Application of a Model for Predicting the Risk of Delirium in Postoperative Patients With Type a Aortic Dissection

Ling²,

Chen³

2021

Front. Surg.

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“…As seen in other ICU patient populations, 2,9 the study by Iwata et al 5 confirms that HF patients with delirium are at a greater risk of experiencing an adverse event beyond their hospital stay. These important findings, however, should be extended to examine other patient-centred health outcomes.…”

mentioning

confidence: 69%

“…This work by Iwata et al 5 further highlights the impact of delirium in a vulnerable cardiac patient population. Teams should seek to determine baseline function, including an assessment of frailty, cognition, medical reconciliation, and history of delirium during previous acute illness to alert the team of potential patient risk.…”

Section: Improving Prognosis For Patients Out Of Hospitalmentioning

confidence: 87%

“…2 Indeed, the consequences of delirium have a profound impact on patient quality of life that will determine whether patients live in good health or simply survive following hospital discharge. This is especially true for patients with HF in the worst health, as shown by Iwata et al 5…”

mentioning

confidence: 89%

“…In this issue of the Canadian Journal of Cardiology, Iwata et al 5 investigated the in-hospital and 1-year prognostic value of delirium assessment in 408 patients recruited from September 2014 to March 2017 with a diagnosis of acute HF requiring ICU care and intravenous diuretics, vasodilators, or inotropes. When patients were systematically assessed with the use of a validated delirium screening tool (Confusion Assessment Method for the ICU), 109 (26.7%) had at least 1 episode of delirium during their ICU stay (52/109 hyperactive [47.7%], 39/109 hypoactive [35.8%], 18/109 mixed [16.5%]).…”

mentioning

confidence: 99%

See 2 more Smart Citations

The Acutely Failing Heart Plus Failing Brain Equals Double Trouble: Clinical Significance of Intensive Care Unit Delirium in Patients With Heart Failure

Kehler

Arora

2020

Canadian Journal of Cardiology

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See article by Iwata et al., pages 1649e1657 of this issue. Problem of Delirium in Heart FailureDelirium is an acute, fluctuating mental state characterized by perturbations or disruptions in consciousness, attention, and reasoning. 1 Although the acute symptoms of delirium usually resolve before discharge, the risk for adverse health outcomes in and out of hospital are greater in a patient who was delirious. 2 Delirium is common in acutely ill patients, particularly in the intensive care unit (ICU), with rates as high as 80%.

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Association of Delirium with Long-Term Mortality in Critically Ill Patients with COPD Who Survived to Discharge: A Retrospective Cohort Study

Xu,

Xue,

et al. 2024

Lung

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Prognostic Value of Delirium in Patients With Acute Heart Failure in the Intensive Care Unit

Cited by 11 publications

References 34 publications

Construction and Application of a Model for Predicting the Risk of Delirium in Postoperative Patients With Type a Aortic Dissection

Construction and Application of a Model for Predicting the Risk of Delirium in Postoperative Patients With Type a Aortic Dissection

The Acutely Failing Heart Plus Failing Brain Equals Double Trouble: Clinical Significance of Intensive Care Unit Delirium in Patients With Heart Failure

Association of Delirium with Long-Term Mortality in Critically Ill Patients with COPD Who Survived to Discharge: A Retrospective Cohort Study

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