震颤谵妄患者致死结局的危险因素——精神科医生的观点：一项巢式病例对照研究。
Risk factors for lethal outcome in patients with delirium tremens - psychiatrist's perspective: a nested case-control study.
机构信息
Center for Clinical Pharmacology, Medical Faculty Military Medical Academy, University of Defence, Crnotravska 17, Belgrade 11000, Serbia.
出版信息
Ann Gen Psychiatry. 2013 Dec 2;12(1):39. doi: 10.1186/1744-859X-12-39.
BACKGROUND
The aim was to identify potential risk factors for lethal outcome in patients with delirium tremens (DT) treated in the psychiatric setting.
METHODS
In a nested case-control study, a total of 190 medical records of patients with DT hospitalized at the Psychiatric Clinic in Serbia between 2002 and 2011 were reviewed and analyzed. The characteristics of patients who died (cases) were compared with those who survived (controls). For each case, two controls (matched for age, gender, and year of hospitalization) were randomly chosen.
RESULTS
Significant differences between cases and controls were found for serum potassium levels (p < 0.001), the number of hospitalizations (p < 0.001), and duration of hospitalization (p < 0.001). A significant association with lethal outcome was found for serum potassium levels even in the normal range (adjusted odds ratio 40.52; 95% CI 1.20, >1,000.00; p = 0.004).
CONCLUSIONS
Even though the number and duration of psychiatric hospitalizations were identified as factors determining survival after admission for DT, only serum potassium levels were found to be significant. Patients with an increase in potassium (or absence of hypokalemia) may require more intensive treatment. Monitoring of serum levels of potassium is important not only as an indicator for replacement but also as an indicator of maladaptation.
背景
本研究旨在确定在精神科环境中接受治疗的震颤谵妄（DT）患者发生致死结局的潜在风险因素。
方法
在一项巢式病例对照研究中，共回顾分析了 2002 年至 2011 年期间在塞尔维亚精神病诊所住院的 190 例 DT 患者的病历。将死亡患者（病例）的特征与存活患者（对照）进行比较。对于每个病例，随机选择 2 名年龄、性别和住院年份匹配的对照。
结果
病例与对照之间在血清钾水平（p < 0.001）、住院次数（p < 0.001）和住院时间（p < 0.001）方面存在显著差异。血清钾水平与致死结局显著相关，即使在正常范围内（调整后的比值比 40.52；95%置信区间 1.20，> 1000.00；p = 0.004）。
结论
尽管入院后 DT 患者的住院次数和住院时间被确定为影响生存的因素，但只有血清钾水平具有显著意义。血钾升高（或无低钾血症）的患者可能需要更强化的治疗。监测血清钾水平不仅是替代治疗的指标，也是适应不良的指标。
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