School of Medicine and Surgery, Milano-Bicocca University, Monza, Italy.
Geriatric Unit, Fondazione IRCCS Ca 'Granda-Ospedale Maggiore Policlinico, Milan, Italy.
J Am Geriatr Soc. 2018 Oct;66(10):2022-2030. doi: 10.1111/jgs.15503. Epub 2018 Sep 21.
To evaluate the relationship between frailty and delirium.
Systematic review and meta-analysis.
MEDLINE, EMBASE, PubMed, Scopus, Web of Science, and Google Scholar databases were searched for articles on frailty and delirium published on or before October 31, 2017.
Individuals aged 65 and older.
Two authors independently reviewed all English-language citations, extracted relevant data, and assessed studies for potential bias. Articles involving pediatric or neurosurgical populations, alcohol or substance abuse, psychiatric illness, head trauma, or stroke, as well as review articles, letters, and case reports were excluded. Studies underwent qualitative or quantitative analysis according to specified criteria. Using a random-effects or fixed-effects model, relative risk (RR) was calculated for the effect of frailty as a predictor of subsequent delirium. Heterogeneity was tested using Q and I statistics.
We identified 1,626 articles from our initial search, of which 20 fulfilled the selection criteria (N=5,541 participants, mean age 77.8). Eight studies were eligible for meta-analysis, showing a significant association between Q2 frailty and subsequent delirium (RR = 2.19, 95% confidence interval = 1.65-2.91). There was low variability among studies in the measures of association between frailty and delirium (I 2.24, p-value Q-statistic = .41) but high heterogeneity in the methods used to assess the two conditions.
This systematic review and meta-analysis supports the existence of an independent relationship between frailty and delirium, although there is notable methodological heterogeneity between the methods used to assess the 2 conditions. Future studies are needed to better delineate the dynamics between these syndromes.
评估衰弱与谵妄之间的关系。
系统评价和荟萃分析。
检索了 MEDLINE、EMBASE、PubMed、Scopus、Web of Science 和 Google Scholar 数据库，以获取截至 2017 年 10 月 31 日发表的关于衰弱和谵妄的文章。
年龄 65 岁及以上的个体。
两位作者独立审查了所有英文引文，提取了相关数据，并评估了研究的潜在偏倚。排除了涉及儿科或神经外科人群、酒精或物质滥用、精神疾病、头部创伤或中风以及综述文章、信件和病例报告的文章。根据指定标准，对研究进行定性或定量分析。使用随机效应或固定效应模型，计算衰弱作为随后发生谵妄的预测因子的效应的相对风险（RR）。使用 Q 和 I 统计量测试异质性。
我们从最初的搜索中确定了 1626 篇文章，其中 20 篇符合选择标准（N=5541 名参与者，平均年龄 77.8 岁）。有 8 项研究符合荟萃分析的条件，表明 Q2 衰弱与随后发生的谵妄之间存在显著关联（RR=2.19，95%置信区间=1.65-2.91）。在衰弱和谵妄之间的关联测量方面，研究之间的变异性较小（I 2=2.24，p 值 Q 统计量=0.41），但用于评估这两种情况的方法存在高度异质性。
本系统评价和荟萃分析支持衰弱与谵妄之间存在独立关系，尽管用于评估这两种情况的方法存在明显的方法学异质性。需要进一步研究以更好地阐明这两种综合征之间的动态关系。
