ICU 中不同类型谵妄患者 90 天死亡率的差异：一项回顾性队列研究。

Differences in 90-day mortality of delirium subtypes in the intensive care unit: A retrospective cohort study.

机构信息

Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, the Netherlands; Radboud Institute of Health Sciences, Radboud university medical center, Nijmegen, the Netherlands.

Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, the Netherlands.

出版信息

J Crit Care. 2019 Oct;53:120-124. doi: 10.1016/j.jcrc.2019.06.007. Epub 2019 Jun 11.

DOI:10.1016/j.jcrc.2019.06.007

PMID:31228762

Abstract

INTRODUCTION

Many intensive care unit (ICU) patients suffer from delirium which is associated with deleterious short-term and long-term effects, including mortality. We determined the association between different delirium subtypes and 90-day mortality.

MATERIALS AND METHODS

Retrospective cohort study in ICU patients admitted in 2015-2017. Delirium, including its subtypes, was determined using the confusion assessment method-ICU (CAM-ICU) and Richmond agitation sedation scale (RASS). Exclusion criteria were insufficient assessments and persistent coma. Cox-regression analysis was used to determine associations of delirium subtypes with 90-day mortality, including relevant covariates (APACHE-IV, length of ICU stay and mechanical ventilation).

RESULTS

7362 ICU patients were eligible of whom 6323 (86%) were included. Delirium occurred in 1600 (25%) patients (stratified for delirium subtype: N = 571-36% mixed, N = 485-30% rapidly reversible, N = 433-27% hypoactive, N = 111-7% hyperactive). The crude hazard ratio (HR) for overall prevalent delirium with 90-day mortality was 2.84 (95%CI: 2.32-3.49), and the adjusted HR 1.29 (95%CI: 1.01-1.65). The adjusted HR for 90-day mortality was 1.57 (95%CI: 1.51-2.14) for the mixed subtype, 1.40 (95%CI: 0.71-2.73) for hyperactive, 1.31 (95%CI: 0.93-1.84) for hypoactive and 0.95 (95%CI: 0.64-1.42) for rapidly reversible delirium.

CONCLUSION

After adjusting for covariates, including competing risk factors, only the mixed delirium subtype was significantly associated with 90-day mortality.

摘要

介绍

许多重症监护病房（ICU）患者患有谵妄，这与短期和长期的有害影响有关，包括死亡率。我们确定了不同谵妄亚型与 90 天死亡率之间的关系。

材料和方法

这是一项 ICU 患者的回顾性队列研究，纳入了 2015 年至 2017 年入住 ICU 的患者。使用意识模糊评估法-重症监护病房（CAM-ICU）和 Richmond 躁动镇静量表（RASS）来确定谵妄及其亚型。排除标准为评估不足和持续昏迷。使用 Cox 回归分析来确定谵妄亚型与 90 天死亡率之间的关联，包括相关协变量（APACHE-IV、ICU 住院时间和机械通气）。

结果

7362 名 ICU 患者符合条件，其中 6323 名（86%）被纳入研究。1600 名（25%）患者发生谵妄（按谵妄亚型分层：N=571-36%混合型，N=485-30%快速可逆型，N=433-27%低反应性型，N=111-7%高反应性型）。总体现患谵妄的粗死亡率风险比（HR）为 2.84（95%CI：2.32-3.49），调整后的 HR 为 1.29（95%CI：1.01-1.65）。混合亚型 90 天死亡率的调整 HR 为 1.57（95%CI：1.51-2.14），高反应性为 1.40（95%CI：0.71-2.73），低反应性为 1.31（95%CI：0.93-1.84），快速可逆性为 0.95（95%CI：0.64-1.42）。