Delirium predicts 12-month mortality
Delirium predicts 12-month mortality
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DOI：
10.1001/archinte.162.4.457
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发表时间：
2002-02-25
影响因子：
--
通讯作者：
Belzile, E
中科院分区：
文献类型：
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作者：
McCusker, J;Cole, M;Belzile, E
背景资料：谵妄尚未被发现是出院后死亡率的一个重要预测因素，但以前的研究存在方法学上的局限性，包括样本量小和对混杂因素的控制不足。本研究旨在确定谵妄的存在、谵妄的类型、谵妄的类型、（发病率与流行率）和谵妄症状的严重程度对老年内科住院患者12个月死亡率的影响。在65岁或65岁以上的患者中进行了一项前瞻性、观察性研究，纳入2个队列的内科住院患者：243例患者有普遍或偶发性谵妄，118例对照组无谵妄。基线测量包括谵妄和/或痴呆的存在、谵妄症状的严重程度、身体功能、合并症以及疾病的生理和临床严重程度。在12个月后的死亡率进行了分析与考克斯比例风险模型与调整的covariates.Results：未调整的危险比谵妄死亡率为3.44（95%置信区间，2.05-5.75），调整后的危险比为2.11（95%置信区间，1.18-3.77）。在调整协变量后，谵妄的影响持续了整个12个月，并且在无痴呆的患者中更强。在痴呆患者中，谵妄对生存率的影响很弱，不显著。调整后的协变量，死亡率并没有显着差异的患者与事件和流行性谵妄，但谵妄患者无痴呆，更严重的谵妄症状与较高的morts.Conclusions：谵妄是一个独立的标志，在老年内科住院患者在入院后的12个月内死亡率增加。它是非痴呆患者中特别重要的预后标志物。
Background: Delirium has not been found to be a significant predictor of postdischarge mortality, but previous research has methodologic limitations including small sample sizes and inadequate control of confounding This study aimed to determine the independent effects of presence of delirium, type of delirium (incident vs prevalent), and severity of delirium symptoms on 12-month mortality among older medical inpatients.Methods: A prospective, observational study of 2 cohorts of medical inpatients was conducted with patients 65 years or older: 243 patients had prevalent or incident delirium, and 118 controls had no delirium. Baseline measures included presence of delirium and/or dementia, severity of delirium symptoms, physical function, comorbidity, and physiological and clinical severity of illness. Mortality during the 12 months after enrollment was analyzed with the Cox proportional hazards model with adjustment for covariates.Results: The unadjusted hazard ratio of delirium with mortality was 3.44 (95% confidence interval, 2.05-5.75); the adjusted hazard ratio was 2.11 (95% confidence interval, 1.18-3.77). The effect of delirium was sustained over the entire 12-month period after adjustment for covariates and was stronger among patients without dementia. Among patients with dementia, there was a weak, nonsignificant effect of delirium on survival. After adjustment for covariates, mortality did not differ between patients with incident and prevalent delirium, but among patients with delirium without dementia, greater severity of delirium symptoms was associated with higher mortality.Conclusions: Delirium is an independent marker for increased mortality among older medical inpatients during the 12 months after hospital admission. It is a particularly important prognostic marker among patients without dementia.