Department of Geriatric Medicine, Oslo University Hospital - Ullevaal, Oslo, Norway.
Dement Geriatr Cogn Disord. 2010;30(2):112-20. doi: 10.1159/000318819. Epub 2010 Aug 21.
The relationship between delirium and mortality remains obscure. The aims of this study were to investigate the effect of delirium and the interaction between delirium and chronic cognitive impairment on mortality in elderly hip fracture patients.
This is a prospective observational study, including 331 hip fracture patients. Information on comorbidity, medications and clinical findings was collected at the time of fracture. Information on cause and time of death was obtained from the Norwegian Cause of Death Register. Patients were screened for delirium by the Confusion Assessment Method.
Delirium was not associated with mortality when adjusting for the severity of chronic cognitive impairment, measured by the Infor- mant Questionnaire on Cognitive Decline in the Elderly (IQCODE). Estimated by Kaplan-Meier plots, delirium in patients with dementia was significantly associated with an increased risk of death from stroke (p = 0.004) and dementia (p ≤ 0.001).
No association between delirium and mortality was demonstrated when adjusting for the IQCODE score, but delirium in patients with prefracture dementia was associated with an increased risk of death from stroke and dementia. The effect of delirium on the cause of death might be explained by an aggravation of an ongoing neuro-inflammation.
谵妄与死亡率之间的关系仍不清楚。本研究旨在探讨谵妄对老年髋部骨折患者死亡率的影响，以及谵妄与慢性认知障碍之间的相互作用对死亡率的影响。
这是一项前瞻性观察研究，共纳入 331 例髋部骨折患者。骨折时收集合并症、药物和临床发现的信息。从挪威死因登记处获取死因和死亡时间的信息。采用意识模糊评估方法筛查谵妄。
在调整慢性认知障碍严重程度（用老年认知减退知情者问卷（IQCODE）衡量）后，谵妄与死亡率之间无关联。通过 Kaplan-Meier 图估计，痴呆患者的谵妄与中风（p = 0.004）和痴呆（p ≤ 0.001）死亡风险增加显著相关。
在调整 IQCODE 评分后，未显示谵妄与死亡率之间存在关联，但骨折前患有痴呆的患者谵妄与中风和痴呆死亡风险增加相关。谵妄对死因的影响可能是由于正在进行的神经炎症加重所致。
