Characteristics associated with delirium in older patients in a medical intensive care unit
Characteristics associated with delirium in older patients in a medical intensive care unit
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DOI：
10.1001/archinte.167.15.1629
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发表时间：
2007-08-13
影响因子：
--
通讯作者：
Inouye, Sharon K.
中科院分区：
文献类型：
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作者：
Pisani, Margaret A.;Murphy, Terrence E.;Inouye, Sharon K.
背景资料：谵妄是一种高度流行的疾病，老年患者在重症监护室。方法：我们进行了前瞻性队列研究，304例60岁或以上的患者从2002年9月5日，通过2004年9月30日，一个14床ICU在城市大学教学医院。主要的结局指标是在ICU入院后48小时内发生的ICU谵妄。采用ICU和病历审查的混乱评估方法对患者进行谵妄评估。通过与代理人的访谈和病历回顾，在ICU入院时评估谵妄的危险因素。一个模型是使用多变量Logistic回归和内部验证bootstrapping methods.Results：谵妄发生在214名研究参与者（70.4%）在ICU入院的第一个48小时内。在多元回归模型中，确定了谵妄的4个入院危险因素。这些风险因素包括痴呆症（比值比[OR]，6.3; 95%置信区间[CI]，2.9-13.8），入住ICU前接受苯二氮卓类药物治疗（OR，3.4; 95% CI，1.6-7.0）、肌酐水平升高（OR，2.1; 95% CI，1.1-4.0）和动脉pH值降低（OR，2.1; 95% CI，1.1-3.9）。C统计量为0.78。结论：谵妄在老年ICU患者中较为常见。入院特征可能是这些患者谵妄的重要标志。了解这些入院风险因素可以促进代谢异常的早期纠正，并可能随后减少谵妄持续时间。
Background: Delirium is a highly prevalent disorder among older patients in the intensive care unit.Methods: We performed a prospective cohort study of 304 patients 60 years or older admitted from September 5, 2002, through September 30, 2004, to a 14-bed ICU in an urban university teaching hospital. The main outcome measure was ICU delirium that developed within 48 hours of ICU admission. Patients were assessed for delirium with the Confusion Assessment Method for the ICU and medical record review. Risk factors for delirium were assessed on ICU admission by interview with proxies and medical record review. A model was developed using multivariate logistic regression and internally validated with bootstrapping methods.Results: Delirium occurred in 214 study participants (70.4%) within the first 48 hours of ICU admission. In a multivariate regression model, 4 admission risk factors for delirium were identified. These risk factors included dementia (odds ratio [OR], 6.3; 95% confidence interval [CI], 2.9-13.8), receipt of benzodiazepines before ICU admission (OR, 3.4; 95% CI, 1.6-7.0), elevated creatinine level (OR, 2.1; 95% CI, 1.1-4.0), and low arterial pH (OR, 2.1; 95% CI, 1.1-3.9). The C statistic was 0.78.Conclusions: Delirium is frequent among older ICU patients. Admission characteristics can be important markers for delirium in these patients. Knowledge of these admission risk factors can prompt early correction of metabolic abnormalities and may subsequently reduce delirium duration.