Long-Term Outcomes in ICU Patients with Delirium: A Population-based Cohort Study.
Long-Term Outcomes in ICU Patients with Delirium: A Population-based Cohort Study.
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DOI：
10.1164/rccm.202002-0320oc
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发表时间：
2021-08-15
影响因子：
24.7
通讯作者：
Stelfox HT
中科院分区：
文献类型：
--
作者：
Fiest KM;Soo A;Hee Lee C;Niven DJ;Ely EW;Doig CJ;Stelfox HT
理由：谵妄在ICU中很常见，预示着更糟糕的ICU和医院预后。ICU谵妄对出院后死亡率和卫生资源利用的影响尚不清楚。目的：评估ICU重症患者出院后2.5年的死亡率和卫生资源使用情况。方法：这是一项基于人群的、倾向评分匹配的回顾性队列研究，研究对象是2014年1月1日至2016年6月30日在14个内科-外科icu中1个icu收治的成年患者。谵妄的测量采用8点重症监护谵妄筛查检查表。主要结局是死亡率。次要终点是随后急诊就诊、再入院或死亡率的综合指标。测量方法和主要结果：共有5936名倾向评分匹配的有或无偶发性谵妄病史的患者存活至出院。谵妄与出院后0-30天死亡率增加相关（风险比为1.44[95%可信区间为1.08-1.92]）。出院后30天以上的死亡率无显著差异（谵妄：3.9%，无谵妄：2.6%）。在整个研究期间，急诊科就诊、再入院或出院后死亡的风险持续增加（风险比为1.12[95%可信区间为1.07-1.17]）。结论：ICU谵妄与出院后0-30天死亡率增高有关。
Rationale: Delirium is common in the ICU and portends worse ICU and hospital outcomes. The effect of delirium in the ICU on post–hospital discharge mortality and health resource use is less well known. Objectives: To estimate mortality and health resource use 2.5 years after hospital discharge in critically ill patients admitted to the ICU. Methods: This was a population-based, propensity score–matched, retrospective cohort study of adult patients admitted to 1 of 14 medical–surgical ICUs from January 1, 2014, to June 30, 2016. Delirium was measured by using the 8-point Intensive Care Delirium Screening Checklist. The primary outcome was mortality. The secondary outcome was a composite measure of subsequent emergency department visits, hospital readmission, or mortality. Measurements and Main Results: There were 5,936 propensity score–matched patients with and without a history of incident delirium who survived to hospital discharge. Delirium was associated with increased mortality 0–30 days after hospital discharge (hazard ratio, 1.44 [95% confidence interval, 1.08–1.92]). There was no significant difference in mortality more than 30 days after hospital discharge (delirium: 3.9%, no delirium: 2.6%). There was a persistent increased risk of emergency department visits, hospital readmissions, or mortality after hospital discharge (hazard ratio, 1.12 [95% confidence interval, 1.07–1.17]) throughout the study period. Conclusions: ICU delirium is associated with increased mortality 0–30 days after hospital discharge.