Days of Delirium Are Associated with 1-Year Mortality in an Older Intensive Care Unit Population
Days of Delirium Are Associated with 1-Year Mortality in an Older Intensive Care Unit Population
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DOI：
10.1164/rccm.200904-0537oc
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发表时间：
2009-12-01
影响因子：
24.7
通讯作者：
Van Ness, Peter H.
中科院分区：
文献类型：
--
作者：
Pisani, Margaret A.;Kong, So Yeon Joyce;Van Ness, Peter H.
基本原理：谵妄是一个经常发生在老年重症监护病房（ICU）患者，但谵妄的持续时间的重要性，在促进不良的长期outcomes.Objectives：探讨ICU谵妄的天数与老年患者population.Methods死亡率的关联：我们进行了一项前瞻性队列研究，在一个14床ICU在城市急性护理医院。患者人群包括304名连续入院的60岁及以上的老年人。测量和主要结果：主要结果是ICU入院后1年的死亡率。每天使用ICU的混乱评估方法和经验证的图表审查方法评估患者的谵妄。ICU谵妄的中位持续时间为3天（范围，1-46天）。在随访期间，153例（50%）患者死亡。在调整相关协变量后，包括年龄、疾病严重程度、共病情况、精神活性药物使用以及基线认知和功能状态，ICU谵妄天数与ICU入院后1年内死亡时间显著相关结论：在老年ICU人群中，调整相关协变量后，ICU谵妄天数与较高的1年死亡率相关。应进行调查，以减少ICU谵妄的天数，并研究这种减少对重要健康结局的影响，包括死亡率和功能及认知状态。
Rationale: Delirium is a frequent occurrence in older intensive care unit (ICU) patients, but the importance of the duration of delirium in contributing to adverse long-term outcomes is unclear.Objectives: To examine the association of the number of days of ICU delirium with mortality in an older patient population.Methods: We performed a prospective cohort study in a 14-bed ICU in an urban acute care hospital. The patient population comprised 304 consecutive admissions 60 years of age and older.Measurements and Main Results: The main outcome was 1-year mortality after ICU admission. Patients were assessed daily for delirium with the Confusion Assessment Method for the ICU and a validated chart review method. The median duration of ICU delirium was 3 days (range,, 1-46 d). During the follow-up period, 153 (50%) patients died. After adjusting for relevant covariates, including age, severity of illness, comorbid conditions, psychoactive medication use, and baseline cognitive and functional status, the number of days of ICU delirium was significantly associated with time to death within 1 year post-ICU admission (hazard ratio, 1.10; 95% confidence interval, 1.02-1.18).Conclusions: Number of days of ICU delirium was associated with higher 1-year mortality after adjustment for relevant covariates in an older ICU population. Investigations should be undertaken to reduce the number of days of ICU delirium and to study the impact of this reduction on important health outcomes, including mortality and functional and cognitive status.