The confusion assessment method for the intensive care unit in patients with cirrhosis.
The confusion assessment method for the intensive care unit in patients with cirrhosis.
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DOI：
10.1007/s11011-015-9679-8
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发表时间：
2015-08
影响因子：
3.6
通讯作者：
Boustani, Malaz A.
中科院分区：
文献类型：
--
作者：
Orman, Eric S.;Perkins, Anthony;Ghabril, Marwan;Khan, Babar A.;Chalasani, Naga;Boustani, Malaz A.
In the intensive care unit (ICU), delirium is routinely measured with the widely-used, validated Confusion Assessment Method for the ICU (CAM-ICU), but CAM-ICU has not been studied in patients with cirrhosis. We studied a group of patients with cirrhosis to determine the relationship between delirium measured by CAM-ICU and clinical outcomes. Consecutive patients with cirrhosis admitted to the ICU from 2009 to 2012 were included in a retrospective cohort study. Patients were screened twice daily for coma and delirium during their ICU stay using the Richmond Agitation Sedation Scale (RASS) and CAM-ICU. The association between delirium/coma and mortality was determined using multiple logistic regression. RASS and CAM-ICU were also compared to a retrospective assessment of hepatic encephalopathy (HE). Of 91 patients with cirrhosis, 26 (28.6%) developed delirium/coma. RASS/CAM-ICU had fair agreement with the HE assessment (κ 0.38). Patients with delirium/coma had numerically greater mortality in-hospital (23.1% vs. 7.7%, p = 0.07) and at 90 days (30.8% vs. 18.5%, p = 0.26), and they also had longer hospital length of stay (median 19.5 vs. 6 days, p < 0.001). Delirium/coma was associated with increased inpatient mortality, independent of disease severity (unadjusted OR 3.6; 95% CI, 0.99–13.1; MELD-adjusted OR 5.4; 95% CI, 1.3–23.8; acute physiology score-adjusted OR 2.2; 95% CI, 0.53–8.9). Delirium/coma was also associated with longer length of stay after adjusting for disease severity. In critically ill patients with cirrhosis, delirium/coma as measured by the RASS and CAM-ICU is associated with increased mortality and hospital length of stay. For these patients, these measures provide valuable information and may be useful tools for clinical care. RASS and CAM-ICU need to be compared to HE-specific measures in future studies.
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影响因子：
39.2
作者：
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影响因子：
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作者：
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通讯作者：
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