Oliver Nathan, Bohorquez Humberto, Anders Stephanie, Freeman Andrew, Fine Kerry, Ahmed Emily, Bruce David S, Carmody Ian C, Cohen Ari J, Seal John, Reichman Trevor W, Loss George E
Department of Pharmacy, Ochsner Clinic Foundation, New Orleans, LA.
Multi-Organ Transplant Institute, Ochsner Clinic Foundation, New Orleans, LA ; The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA.
Ochsner J. 2017 Spring;17(1):25-30.
Incidence of delirium after liver transplantation (LT) has been reported to occur in 10%-47% of patients and is associated with increased hospital and intensive care unit lengths of stay and poor outcomes.
Our primary objective was to evaluate the incidence and predisposing risk factors for developing delirium after LT. Our secondary objectives were to describe how delirium is managed in patients after LT, to examine the utilization of resources associated with delirium after LT, and to analyze the outcomes of patients who were treated for delirium after LT.
In a population of 181 consecutive patients who received an LT, 38 (21.0%) developed delirium. In the multivariate analysis, delirium was associated with pretransplant use of antidepressants (odds ratio [OR] 3.34, 95% confidence interval [CI] 1.29-8.70) and pretransplant hospital admission for encephalopathy (OR 4.39, 95% CI 1.77-10.9). Patients with delirium spent more time on mechanical ventilation (2.0 vs 1.3 days, =0.008) and had longer intensive care unit stays (4.6 vs 2.7 days, =0.008), longer hospital stays (27.6 vs 11.2 days, =0.003), and higher 6-month mortality (13.2% vs 1.4%, =0.003) than patients who did not develop delirium.
The presence of delirium is common after LT and is associated with high morbidity and mortality within the first 6 months posttransplant. Pretransplant factors independently associated with developing delirium after LT include prior use of antidepressants and pretransplant hospital admission for encephalopathy. Efforts should be made to identify patients at risk for delirium, as protocol-based management may improve outcomes in a cost-effective manner.
据报道，肝移植（LT）后谵妄的发生率在10%至47%的患者中出现，并且与住院时间和重症监护病房停留时间的增加以及不良预后相关。
我们的主要目标是评估LT后发生谵妄的发生率和诱发风险因素。我们的次要目标是描述LT后患者谵妄的管理方式，检查LT后与谵妄相关的资源利用情况，并分析LT后接受谵妄治疗的患者的结局。
在181例连续接受LT的患者群体中，38例（21.0%）发生了谵妄。在多变量分析中，谵妄与移植前使用抗抑郁药（比值比[OR] 3.34，95%置信区间[CI] 1.29 - 8.70）以及移植前因脑病住院（OR 4.39，95% CI 1.77 - 10.9）相关。与未发生谵妄的患者相比，发生谵妄的患者机械通气时间更长（2.0天对1.3天，P = 0.008），重症监护病房停留时间更长（4.6天对2.7天，P = 0.008），住院时间更长（27.6天对11.2天，P = 0.003），6个月死亡率更高（13.2%对1.4%，P = 0.003）。
LT后谵妄很常见，并且与移植后前6个月内的高发病率和死亡率相关。与LT后发生谵妄独立相关的移植前因素包括先前使用抗抑郁药和移植前因脑病住院。应努力识别有谵妄风险的患者，因为基于方案的管理可能以具有成本效益的方式改善结局。
