Prognostic Value of Delirium in Patients With Acute Heart Failure in the Intensive Care Unit
Prognostic Value of Delirium in Patients With Acute Heart Failure in the Intensive Care Unit
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DOI：
10.1016/j.cjca.2020.01.006
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发表时间：
2020-10-01
影响因子：
6.2
通讯作者：
Murohara, Toyoaki
中科院分区：
文献类型：
--
作者：
Iwata, Etsuo;Kondo, Toru;Murohara, Toyoaki
背景：谵妄是一种常见的不良事件，在重症监护室（ICU）的患者中观察到。然而，谵妄的预后价值及其决定因素尚未得到彻底调查，在急性心力衰竭（AHF）患者。方法：我们调查了408例连续的AHF患者入住ICU。结果：109例患者发生谵妄，发生率为26.7%，谵妄患者的住院死亡率明显高于其他患者（13.8% vs2.3%，P < 0.001）。多因素Logistic回归分析显示谵妄独立预测院内死亡率（优势比[OR] 4.33，可信区间[CI] 1.62-11.52; P = 0.003）。Kaplan-Meier分析显示谵妄患者的12个月死亡率显著高于无谵妄患者（log-rank检验：P < 0.001），考克斯比例风险分析显示谵妄仍然是12个月死亡率的独立预测因素（风险比2.19，95%CI 1.49-3.25; P < 0.001）。谵妄的发生率与心力衰竭的严重程度相关，通过指南心力衰竭风险评分进行评估（卡方检验：P = 0.003）。年龄（OR 1.05，95%CI 1.02-1.09; P = 0.003），疗养院居住状态（OR 3.32，95% CI 1.59-6.94; P = 0.001），和痴呆（OR 5.32，95%CI 2.83-10.00; P < 0.001）与谵妄的发生独立相关。ICU期间谵妄的发生与短期和长期死亡率相关，并可通过心力衰竭的严重程度、疗养院居住和痴呆状态进行预测。
Background: Delirium is a common adverse event observed in patients admitted to the intensive care unit (ICU). However, the prognostic value of delirium and its determinants have not been thoroughly investigated in patients with acute heart failure (AHF).Methods: We investigated 408 consecutive patients with AHF admitted to the ICU. Delirium was diagnosed by means of the Confusion Assessment Method for ICU tool and evaluated every 8 hours during the patients' ICU stays.Results: Delirium occurred in 109 patients (26.7%), and the inhospital mortality rate was significantly higher in patients with delirium (13.8% vs 2.3%; P < 0.001). Multivariate logistic regression analysis showed that delirium independently predicted in-hospital mortality (odds ratio [OR] 4.33, confidence interval [CI] 1.62-11.52; P = 0.003). Kaplan-Meier analysis showed that the 12-month mortality rate was significantly higher in patients with delirium compared with those without (log-rank test: P < 0.001), and Cox proportional hazards analysis showed that delirium remained an independent predictor of 12-month mortality (hazard ratio 2.19, 95% CI 1.49-3.25; P < 0.001). The incidence of delirium correlated with severity of heart failure as assessed by means of the Get With The GuidelineseHeart Failure risk score (chi-square test: P = 0.003). Age (OR 1.05, 95% CI 1.02-1.09; P = 0.003), nursing home residential status (OR 3.32, 95% CI 1.59-6.94; P = 0.001), and dementia (OR 5.32, 95% CI 2.83-10.00; P < 0.001) were independently associated with the development of delirium.Conclusions: Development of delirium during ICU stay is associated with short- and long-term mortality and is predicted by the severity of heart failure, nursing home residential, and dementia status.