Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan; Department of Cardiology, Nagoya Ekisaikai Hospital, Nagoya, Aichi, Japan.
Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
Can J Cardiol. 2020 Oct;36(10):1649-1657. doi: 10.1016/j.cjca.2020.01.006. Epub 2020 Jan 16.
Delirium is a common adverse event observed in patients admitted to the intensive care unit (ICU). However, the prognostic value of delirium and its determinants have not been thoroughly investigated in patients with acute heart failure (AHF).
We investigated 408 consecutive patients with AHF admitted to the ICU. Delirium was diagnosed by means of the Confusion Assessment Method for ICU tool and evaluated every 8 hours during the patients' ICU stays.
Delirium occurred in 109 patients (26.7%), and the in-hospital mortality rate was significantly higher in patients with delirium (13.8% vs 2.3%; P < 0.001). Multivariate logistic regression analysis showed that delirium independently predicted in-hospital mortality (odds ratio [OR] 4.33, confidence interval [CI] 1.62-11.52; P = 0.003). Kaplan-Meier analysis showed that the 12-month mortality rate was significantly higher in patients with delirium compared with those without (log-rank test: P < 0.001), and Cox proportional hazards analysis showed that delirium remained an independent predictor of 12-month mortality (hazard ratio 2.19, 95% CI 1.49-3.25; P < 0.001). The incidence of delirium correlated with severity of heart failure as assessed by means of the Get With The Guidelines-Heart Failure risk score (chi-square test: P = 0.003). Age (OR 1.05, 95% CI 1.02-1.09; P = 0.003), nursing home residential status (OR 3.32, 95% CI 1.59-6.94; P = 0.001), and dementia (OR 5.32, 95% CI 2.83-10.00; P < 0.001) were independently associated with the development of delirium.
Development of delirium during ICU stay is associated with short- and long-term mortality and is predicted by the severity of heart failure, nursing home residential, and dementia status.
谵妄是重症监护病房（ICU）患者中常见的不良事件。然而，在急性心力衰竭（AHF）患者中，谵妄的预后价值及其决定因素尚未得到彻底研究。
我们调查了 408 例连续入住 ICU 的 AHF 患者。使用 ICU 意识模糊评估方法工具诊断谵妄，并在患者 ICU 住院期间每 8 小时评估一次。
109 例（26.7%）患者发生谵妄，谵妄患者住院死亡率明显较高（13.8%比 2.3%；P<0.001）。多变量 logistic 回归分析显示，谵妄独立预测住院死亡率（比值比[OR] 4.33，95%置信区间[CI] 1.62-11.52；P=0.003）。Kaplan-Meier 分析显示，与无谵妄患者相比，谵妄患者 12 个月死亡率明显较高（对数秩检验：P<0.001），Cox 比例风险分析显示，谵妄仍然是 12 个月死亡率的独立预测因素（风险比 2.19，95%CI 1.49-3.25；P<0.001）。谵妄的发生率与通过 Get With The Guidelines-Heart Failure 风险评分评估的心力衰竭严重程度相关（卡方检验：P=0.003）。年龄（OR 1.05，95%CI 1.02-1.09；P=0.003）、疗养院居住状态（OR 3.32，95%CI 1.59-6.94；P=0.001）和痴呆（OR 5.32，95%CI 2.83-10.00；P<0.001）与谵妄的发生独立相关。
入住 ICU 期间发生谵妄与短期和长期死亡率相关，并可由心力衰竭严重程度、疗养院居住状态和痴呆状态预测。
