Department of Geriatric Medicine, Diakonessenhuis Utrecht, the Netherlands; Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons (EPHOR), University Medical Centre Utrecht, Utrecht University, the Netherlands.
Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons (EPHOR), University Medical Centre Utrecht, Utrecht University, the Netherlands.
Eur J Intern Med. 2020 Aug;78:121-126. doi: 10.1016/j.ejim.2020.04.062. Epub 2020 May 30.
Anticholinergic drugs may increase the risk of delirium in non-critically ill patients, but it is unclear whether exposure to these drugs is also a risk factor for Intensive Care Unit (ICU) delirium. In this study the hypothesis was tested that anticholinergic drug exposure at ICU admission increases the risk to develop delirium during ICU stay, particularly in patients with advanced age and severe sepsis.
A prospective cohort study was performed in the mixed 32-bed medical-surgical ICU of the University Medical Center Utrecht, the Netherlands in the period from January 2011 till June 2013. Included were nonneurological patients that were consecutively admitted for more than 24 hours. The presence of delirium was evaluated each day using a validated algorithm based on the Confusion Assessment Method for the ICU (CAM-ICU), the initiation of delirium treatment as well as chart review by researchers. Anticholinergic drug exposure at ICU admission was assessed using the Anticholinergic Drug Scale (ADS). To evaluate the association between anticholinergic drug exposure at ICU admission and the risk of developing delirium, we performed multivariable competing risk Cox proportional hazard analysis corrected for confounding factors.
Approximately half (47%, n=513) of the 1090 included patients developed delirium during ICU admission. The absolute risk for delirium development increased with more anticholinergic drug exposure: 42% in patients with ADS score=0, 49% in patients with ADS score=1, and 53% in patients with ADS higher than 1. Taking competing events (death and discharge) and potential confounding factors into account, the subdistribution hazard ratio (SHR) was 1.13 (95% CI: 0.91-1.40) for ADS score=1 point and 1.35 (95% CI: 1.09-1.68) for ADS ≥2 compared with an ADS score=0 (no anticholinergic drug exposure). The effect was strongest during the first days of ICU admittance and was strongest in patients above 65 year without severe sepsis and/or septic shock (SHR 2.15, 95% CI 1.43-3.25).
Anticholinergic drug exposure at ICU admission increases the risk of delirium in critically ill patients. This effect was most pronounced in patients older than 65 years without severe sepsis and/or septic shock, and declining over time.
抗胆碱能药物可能会增加非危重病患者发生谵妄的风险，但目前尚不清楚这些药物的暴露是否也是重症监护病房（ICU）谵妄的一个危险因素。在这项研究中，研究人员假设 ICU 入院时的抗胆碱能药物暴露会增加 ICU 住院期间发生谵妄的风险，特别是在年龄较大和患有严重败血症的患者中。
这是一项在荷兰乌得勒支大学医学中心混合的 32 张病床的内科-外科 ICU 中进行的前瞻性队列研究。研究纳入了连续入住 ICU 超过 24 小时的非神经科患者。使用基于 ICU 意识模糊评估法（CAM-ICU）的验证算法，每天评估患者是否存在谵妄，同时进行谵妄治疗的启动和研究者进行病历审查。ICU 入院时的抗胆碱能药物暴露情况使用抗胆碱能药物量表（ADS）进行评估。为了评估 ICU 入院时的抗胆碱能药物暴露与发生谵妄的风险之间的关联，我们使用多变量竞争风险 Cox 比例风险分析校正了混杂因素。
在纳入的 1090 名患者中，约有一半（47%，n=513）在 ICU 住院期间发生了谵妄。随着抗胆碱能药物暴露的增加，发生谵妄的绝对风险也随之增加：ADS 评分为 0 的患者中为 42%，ADS 评分为 1 的患者中为 49%，ADS 评分大于 1 的患者中为 53%。考虑到竞争事件（死亡和出院）和潜在的混杂因素，ADS 评分增加 1 分的亚分布危险比（SHR）为 1.13（95%CI：0.91-1.40），ADS 评分大于等于 2 分的 SHR 为 1.35（95%CI：1.09-1.68），与 ADS 评分为 0（无抗胆碱能药物暴露）相比。这种影响在 ICU 入院的最初几天最为明显，在年龄大于 65 岁且无严重败血症和/或感染性休克的患者中最为明显（SHR 2.15，95%CI 1.43-3.25）。
ICU 入院时的抗胆碱能药物暴露会增加危重病患者发生谵妄的风险。这种影响在年龄大于 65 岁且无严重败血症和/或感染性休克的患者中最为明显，且随着时间的推移而下降。
