Does Alzheimer's Disease and Related Dementias Modify Delirium Severity and Hospital Outcomes?
Does Alzheimer's Disease and Related Dementias Modify Delirium Severity and Hospital Outcomes?
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DOI：
10.1111/jgs.16420
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发表时间：
2020-08
影响因子：
6.3
通讯作者：
BASIL Study Group
中科院分区：
文献类型：
--
作者：
Hshieh TT;Fong TG;Schmitt EM;Marcantonio ER;Xu G;Gou YR;Travison TG;Metzger ED;Jones RN;Inouye SK;BASIL Study Group
我们研究了患有和不患有阿尔茨海默病及相关痴呆（ADRD）的患者谵妄严重程度与谵妄结局之间的关系。对某学术三级医疗中心内科和外科患者的前瞻性队列研究（N=352）。住院期间每日使用精神错乱评估法（CAM）和精神错乱严重程度（CAM- s）评分评定谵妄发生率和严重程度。严重谵妄被定义为CAM-S简短形式得分最高的分位数（3-7分）。ADRD状态由临床共识过程确定。临床结果包括住院时间延长（6 ~ 6天）、急性后护理机构出院、与院前基线相比一个月的日常生活活动（adl）下降、持续护理机构住院和死亡率。ADRD患者（n=85, 24%）发生谵妄的相对危险度（RR）显著增高，RR=2.31, 95%可信区间（CI） 1.64 ~ 3.28，峰值CAM-S评分较高，平均差异=1.24分，CI 0.83 ~ 1.65 （p<0.001）。在ADRD患者中，严重谵妄显著增加护理机构住院的相对风险（RR=2.22, CI 1.05 ~ 4.69）， p=0.04，显著增加死亡的相对风险（RR=2.10, CI 0.89 ~ 4.98）， p=0.09。在无ADRD的患者中，严重谵妄与除死亡率外所有不良结局的风险显著增加相关，包括住院时间延长（RR=1.47, CI 1.18-1.82）和急性后护理机构出院（RR=2.17, CI 1.58-2.98）， adl下降（RR=1.30, CI 1.05-1.60）和护理机构住院1个月（RR=1.93, CI 1.31-2.83）。严重谵妄与有或无ADRD患者不良临床结果的风险增加相关。在两组中，严重的谵妄都增加了被安置在养老院的风险。在ADRD患者中，谵妄更为严重，并与1个月死亡率增加的趋势相关。虽然相对风险增加的风险仍然很大，但该研究在检查罕见的死亡结果方面的能力有限。
We examined the association between delirium severity and outcomes of delirium among persons with and without Alzheimer’s Disease and Related Dementias (ADRD). Prospective cohort study at of medical and surgical patients at an academic tertiary medical center (N=352). Delirium incidence and severity were rated daily using the Confusion Assessment Method (CAM) and CAM-severity (CAM-S) score during hospitalization. Severe delirium was defined as a CAM-S short form score in the highest tertile (3-7 points out of 7). ADRD status was determined by a clinical consensus process. Clinical outcomes included prolonged length of stay (>6 days), discharge to post-acute nursing facility, any decline in Activities of Daily Living (ADLs) at one month from pre-hospital baseline, ongoing nursing facility stay and mortality. Patients with ADRD (n=85, 24%) had significantly higher relative risk (RR) for incident delirium, RR=2.31, 95% Confidence Interval (CI) 1.64-3.28 and higher peak CAM-S scores, mean difference=1.24 points, CI 0.83-1.65 (p<0.001). Among patients with ADRD, severe delirium significantly increased the relative risk for nursing facility stay (RR=2.22, CI 1.05-4.69), p=0.04 and increased the relative risk for mortality (RR=2.10, CI 0.89-4.98), p=0.09. Among patients without ADRD, severe delirium was associated with significantly increased risk for all poor outcomes except mortality – including prolonged length of stay in hospital (RR=1.47, CI 1.18-1.82) and discharge to post-acute nursing facility (RR=2.17, CI 1.58-2.98) plus decline in ADLs (RR=1.30, CI 1.05-1.60) and nursing facility stay at one-month (RR=1.93, CI 1.31-2.83). Severe delirium is associated with increased risk for poor clinical outcomes in patients with and without ADRD. In both groups, severe delirium increased risk of nursing home placement. In patients with ADRD, delirium was more severe and associated with a trend towards increased mortality at one month. While the increased risk remains substantial by relative risk, the study had limited power to examine the rarer outcome of death.
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CAM-S：在2个队列中del妄严重性的新评分系统的开发和验证。
影响因子：
39.2
作者：
Inouye SK;Kosar CM;Tommet D;Schmitt EM;Puelle MR;Saczynski JS;Marcantonio ER;Jones RN
通讯作者：
Jones RN
DOI：
10.1093/gerona/60.6.748
发表时间：
2005-06-01
影响因子：
5.1
作者：
Fick, DM;Kolanowski, AM;Inouye, SK
通讯作者：
Inouye, SK
影响因子：
168.9
作者：
Inouye, Sharon K.;Westendorp, Rudi G. J.;Saczynski, Jane S.
通讯作者：
Saczynski, Jane S.
影响因子：
14
作者：
通讯作者：
--
影响因子：
6.9
作者：
JORM, AF
通讯作者：
JORM, AF