Confusion assessment method accurately screens for hepatic encephalopathy and predicts short-term mortality in hospitalized patients with cirrhosis
Confusion assessment method accurately screens for hepatic encephalopathy and predicts short-term mortality in hospitalized patients with cirrhosis
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DOI：
10.1007/s11011-022-01149-4
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发表时间：
2022-12-19
影响因子：
3.6
通讯作者：
Orman，Eric S.
中科院分区：
文献类型：
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作者：
Desai，Archita P.;Gandhi，Devika;Orman，Eric S.
肝性脑病（HE）是谵妄的一种亚型，在肝硬化中很常见，并且与不良预后相关。然而，缺乏客观的 HE 床边筛查工具。我们检查了已建立的谵妄筛查工具、重症监护病房混乱评估方法 (CAM-ICU) 与短期结果之间的关系，同时将其性能与先前建立的认知功能测量方法（如西黑文标准 (WHC)）进行比较。对 2014 年 6 月 6 日至 2018 年 6 月完成 CAM-ICU 的前瞻性入组肝硬化成人患者进行了 90 天的随访。收集了由盲法提供者指定的西黑文标准 (WHC) 和其他认知功能衡量标准。使用逻辑回归来测试 CAM-ICU 状态和结果之间的关联。使用接受者操作特征曲线下面积 (AUROC) 评估 CAM-ICU 状态的死亡率预测。在 469 名参与者中，11% 为 CAM-ICU( +)，55% 为男性，94% 为白人。大多数患者为 Childs-Pugh C 级（59%）。 CAM-ICU 与 WHC 具有极好的一致性（Kappa = 0.79）。 CAM-ICU( +) 参与者与 CAM-ICU(-) 参与者具有相似的人口特征，但 MELD 较高（25 vs. 19，p< 0.0001），更常入住 ICU（28% vs. 7%，p< 0.0001），并且更有可能因 HE 和感染而入院。 CAM-ICU( +) 参与者的死亡率较高（住院患者：37% vs. 3%，30 天：51% vs. 11%，90 天：63% vs. 23%，p< 0.001）。 CAM-ICU 状态预测住院患者死亡率、30 天死亡率和 90 天死亡率的 AUROC 分别为 0.85、0.82 和 0.77。 CAM-ICU 可以轻松筛查谵妄/HE，与 WHC 具有良好的一致性，并识别短期死亡率较高的住院肝硬化队列。
Hepatic encephalopathy (HE), a subtype of delirium, is common in cirrhosis and associated with poor outcomes. Yet, objective bedside screening tools for HE are lacking. We examined the relationship between an established screening tool for delirium, Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) and short-term outcomes while comparing its performance with previously established measures of cognitive function such as West Haven criteria (WHC). Prospectively enrolled adults with cirrhosis who completed the CAM-ICU from 6/2014–6/2018 were followed for 90 days. Blinded provider-assigned West Haven Criteria (WHC) and other measures of cognitive function were collected. Logistic regression was used to test associations between CAM-ICU status and outcomes. Mortality prediction by CAM-ICU status was assessed using Area under the Receiver Operating Characteristics curves (AUROC). Of 469 participants, 11% were CAM-ICU( +), 55% were male and 94% were White. Most patients were Childs-Pugh class C (59%). CAM-ICU had excellent agreement with WHC (Kappa = 0.79). CAM-ICU( +) participants had similar demographic features to those CAM-ICU(-), but had higher MELD (25 vs. 19,p< 0.0001), were more often admitted to the ICU (28% vs. 7%,p< 0.0001), and were more likely to be admitted for HE and infection. CAM-ICU( +) participants had higher mortality (inpatient:37% vs. 3%, 30-day:51% vs. 11%, 90-day:63% vs. 23%,p< 0.001). CAM-ICU status predicted mortality with AUROC of 0.85, 0.82 and 0.77 for inpatient, 30-day and 90-day mortality, respectively. CAM-ICU easily screens for delirium/HE, has excellent agreement with WHC, and identifies a hospitalized cirrhosis cohort with high short-term mortality.