Department of Neurology, Jagiellonian University Medical College, Kraków, Poland.
Eur J Neurol. 2019 Jun;26(6):927-934. doi: 10.1111/ene.13912. Epub 2019 Mar 1.
Subsyndromal delirium (SSD) refers to patients with delirious symptoms who do not meet the criteria for delirium. The aim was to determine the prognostic significance of SSD in stroke patients.
In all, 564 patients with ischaemic stroke (median age 71 years, 50.5% female) were included. The Confusion Assessment Method was used to assess symptoms of delirium and the Diagnostic and Statistical Manual of Mental Disorders, 5th edn, criteria were used to diagnose delirium. SSD was defined as one or more core features of delirium without fulfilling diagnostic criteria. Functional outcome was assessed using the modified Rankin Scale at 3 and 12 months after stroke.
Delirium was diagnosed in 23.4% of patients and SSD in 10.3% of patients. SSD was associated with increased risk of poor functional outcome. The adjusted odds ratios (ORs) for unfavourable outcome at 3 and 12 months were 2.88 [95% confidence interval (CI) 1.43-5.79, P < 0.01] and 2.93 (95% CI 1.39-6.22, P < 0.01), respectively. In multivariate analysis, delirium was an independent predictor of poor functional outcome at 3 months (OR 6.41, 95% CI 3.36-12.21, P < 0.01) and 12 months (OR 6.11, 95% CI 3.05-12.27, P < 0.01) after stroke. Delirium was also independently associated with increased risk of death within 3 months (hazard ratio 3.68, 95% CI 1.69-8.02, P < 0.01) and 12 months (hazard ratio 3.76, 95% CI 2.05-6.90, P < 0.01). SSD was not associated with increased risk of death.
In SSD patients the risk of poor functional outcome after stroke is increased and intermediate between patients with and patients without delirium.
亚综合征性谵妄（SSD）是指存在谵妄症状但不符合谵妄诊断标准的患者。本研究旨在明确 SSD 对脑卒中患者的预后意义。
共纳入 564 例缺血性脑卒中患者（中位年龄 71 岁，50.5%为女性）。采用意识模糊评估法评估谵妄症状，采用《精神障碍诊断与统计手册（第五版）》标准诊断谵妄。SSD 定义为存在 1 项或多项谵妄核心特征但不符合诊断标准。采用脑卒中患者改良 Rankin 量表于卒中后 3 个月和 12 个月评估功能结局。
23.4%的患者诊断为谵妄，10.3%的患者诊断为 SSD。SSD 与不良功能结局风险增加相关。卒中后 3 个月和 12 个月时不良结局的校正优势比（OR）分别为 2.88（95%置信区间[CI] 1.43-5.79，P<0.01）和 2.93（95%CI 1.39-6.22，P<0.01）。多变量分析显示，谵妄是卒中后 3 个月（OR 6.41，95%CI 3.36-12.21，P<0.01）和 12 个月（OR 6.11，95%CI 3.05-12.27，P<0.01）时不良功能结局的独立预测因素。谵妄还与卒中后 3 个月内（风险比[HR] 3.68，95%CI 1.69-8.02，P<0.01）和 12 个月内（HR 3.76，95%CI 2.05-6.90，P<0.01）死亡风险增加相关。SSD 与死亡风险增加无关。
在 SSD 患者中，卒中后不良功能结局的风险增加，处于存在谵妄和不存在谵妄患者之间。
