Smith Patrick, Thompson Jillian C, Perea Elena, Wasserman Brian, Bohannon Lauren, Racioppi Alessandro, Choi Taewoong, Gasparetto Cristina, Horwitz Mitchell E, Long Gwynn, Lopez Richard, Rizzieri David A, Sarantopoulos Stefanie, Sullivan Keith M, Chao Nelson J, Sung Anthony D
Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina.
Department of Medicine, Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina.
Biol Blood Marrow Transplant. 2020 Dec;26(12):2323-2328. doi: 10.1016/j.bbmt.2020.09.016. Epub 2020 Sep 19.
Delirium is common among adults undergoing hematopoietic stem cell transplantation (HCT), although the clinical and neuroimaging correlates of post-HCT delirium have not been adequately delineated. We therefore examined the frequency of delirium and neuroimaging correlates of post-transplant delirium in a retrospective cohort of 115 adults undergoing neuroimaging after allogeneic HCT. Delirium was established using previously validated methods for retrospective identification of chart-assessed postprocedural delirium. Chart reviews were independently conducted by a multidisciplinary team with expertise in HCT, psychiatry, and psychology on consecutive allogeneic HCT patients who underwent neuroimaging assessments and transplantation at a single center between January 2009 and December 2016. Neuroimaging markers of white matter damage and brain volume loss were also recorded. In total, 115 patients were included, ranging in age from 20 to 74 years (mean [SD] age, 49 [13]). Fifty-three patients (46%) developed post-HCT delirium. In an adjusted model, delirium incidence was associated with older age (odds ratio [OR], 1.92 [1.28, 2.87] per decade, P = .002), greater severity of white matter hyperintensities (OR, 1.95 [1.06, 3.57], P = .031), and conditioning intensity (OR, 6.37 [2.20, 18.45], P < .001) but was unrelated to cortical atrophy (P = .777). Delirium was associated with fewer hospital-free days (P = .023) but was not associated with overall survival (hazard ratio, 0.95 [0.56, 1.61], P = .844). Greater incidence of delirium following HCT was associated with greater age, microvascular burden, and conditioning intensity. Pre-HCT consideration of microvascular burden and other neuroimaging biomarkers of risk may be warranted.
谵妄在接受造血干细胞移植（HCT）的成年人中很常见，尽管HCT后谵妄的临床和神经影像学相关性尚未得到充分描述。因此，我们在一个回顾性队列中研究了115名接受异基因HCT后进行神经影像学检查的成年人中谵妄的发生率以及移植后谵妄的神经影像学相关性。使用先前验证的方法对图表评估的术后谵妄进行回顾性识别来确定谵妄。图表审查由一个多学科团队独立进行，该团队由在HCT、精神病学和心理学方面具有专业知识的人员组成，研究对象为2009年1月至2016年12月期间在单一中心接受神经影像学评估和移植的连续异基因HCT患者。还记录了白质损伤和脑容量损失的神经影像学标志物。总共纳入了115名患者，年龄在20至74岁之间（平均[标准差]年龄，49[13]）。53名患者（46%）发生了HCT后谵妄。在一个校正模型中，谵妄发生率与年龄较大（每十年优势比[OR]，1.92[1.28，2.87]，P = 0.002）、白质高信号强度更严重（OR，1.95[1.06，3.57]，P = 0.031）以及预处理强度（OR，6.37[2.20，18.45]，P < 0.001）相关，但与皮质萎缩无关（P = 0.777）。谵妄与无住院天数减少相关（P = 0.023），但与总生存期无关（风险比，0.95[0.56，1.61]，P = 0.844）。HCT后谵妄发生率较高与年龄较大、微血管负担和预处理强度较大相关。HCT前考虑微血管负担和其他风险神经影像学生物标志物可能是有必要的。
