Associations of delirium with in-hospital and in 6-months mortality in elderly medical inpatients
Associations of delirium with in-hospital and in 6-months mortality in elderly medical inpatients
复制标题
DOI：
10.1093/ageing/afm094
复制
发表时间：
2007-11-01
期刊：
影响因子：
6.7
通讯作者：
Martin, Finbarr C.
中科院分区：
文献类型：
--
作者：
Adamis, Dimitrios;Treloar, Adrian;Martin, Finbarr C.
关于老年住院患者死亡率与谵妄之间关系的背景研究得出了相互矛盾的结果。这种不一致可能是由于临床或潜在病理生理过程方面的病例组合差异所致。例如，白蛋白和 C 反应蛋白 (CRP) 已被报道为院内死亡率和长期死亡率的白细胞介素 6 的预测因子。我们使用谵妄纵向研究的数据来调查谵妄与死亡率之间的关系。一组由 164 名 70 岁以上患者组成的队列在急性入院后 3 天内进行评估，因此每周两次直至出院，评估谵妄的存在和严重程度以及一系列临床和实验室指标，包括初始白蛋白 (n=149)、CRP (n=76) 和细胞因子 (n=60) 水平。院内死亡率和 6 个月死亡率根据临床记录和电话联系确定。结果住院期间 14 名 (8.5%) 患者死亡，其中 6 名患者出现谵妄：死亡率与谵妄无关。 6 个月时，150 名出院患者中有 119 名（77.3%）仍然活着，21 名（14.0%）死亡，13 名（8.7%）无法联系。在双变量分析中，6 个月死亡率与年龄较大 (P=0.013)、较低白蛋白 (P=0.001)、较高 CRP (P=0.014) 和较高白细胞介素 6 水平 (P=0.007) 相关，但与院内谵妄的存在或严重程度无关。控制其他变量后，六个月死亡率的显着预测因子（P < 0.05）是初始 MMSE、白蛋白、干扰素和白细胞介素 6。结论是，谵妄与死亡率之间缺乏明显的关联，可能反映出本研究中由于数字较低而统计功效不足。然而，这些发现强调了特定的病理生理因素，这些因素可能对谵妄后的预后很重要。
Background studies on the association between mortality and delirium in older hospital inpatients have produced conflicting results. This insconsistency might be explained by case-mix differences in terms of clinical or underlying patho-physiological processes. For example, both albumin and C-reactive protein (CRP) have been reported as predictors of in-hospital mortality and interleukin-6 of longer-term mortality.Methods we used data from a longitudinal study of delirium to investigate the deliriummortality relationship. A cohort of 164 patients, 70+ years were assessed within 3 days of acute hospital admission and hence twice weekly until hospital discharge, for the presence and severity of delirium and a range of clinical and laboratory measures, including initial albumin (n=149), CRP (n=76) and cytokine (n=60) levels. In-hospital and 6-months mortality were determined from clinical records and telephone contact.Results during hospitalisation 14 (8.5%) patients died, 6 with delirium: mortality was not associated with delirium. At 6 months, 119 of 150 (77.3%) discharged patients were still alive, 21 (14.0%) dead, and 13 (8.7%) uncontactable. In bivariate analysis, 6-months mortality was associated with older age (P=0.013), lower albumin (P=0.001), higher CRP (P=0.014) and higher interleukin-6 levels (P=0.007), but not with presence or severity of in-hospital delirium. After controlling for other variables significant predictors (P < 0.05) for six-month mortality were initial MMSE, albumin, interferon- and interleukin-6.Conclusions the lack of demonstrable association between delirium and mortality may reflect inadequate statistical power in this study due to low numbers. These findings, however, highlight specific patho-physiological factors which may be important in the prognosis after delirium.