Miyamoto Kyohei, Nakashima Tsuyoshi, Shima Nozomu, Kato Seiya, Kawazoe Yu, Morimoto Takeshi, Ohta Yoshinori, Yamamura Hitoshi
Department of Emergency and Critical Care Medicine Wakayama Medical University Wakayama Japan.
Department of Emergency and Critical Care Medicine Tohoku University Graduate School of Medicine Sendai Japan.
Acute Med Surg. 2020 Nov 4;7(1):e589. doi: 10.1002/ams2.589. eCollection 2020 Jan-Dec.
Delirium frequently develops in patients with sepsis during their intensive care unit (ICU) stay, which is associated with increased morbidity and mortality. A prediction model for delirium in patients in ICU, PRE-DELIRIC, has been utilized in overall ICU patients, but its utility is uncertain among patients with sepsis. This study aims to examine the utility of PRE-DELIRIC to predict delirium in mechanically ventilated patients with sepsis.
This is a post hoc analysis of a randomized clinical trial in eight Japanese ICUs, which aimed to evaluate the sedative strategy with/without dexmedetomidine in adult mechanically ventilated patients with sepsis. The Confusion Assessment Method for the ICU was used every day to assess for delirium throughout their ICU stay. We excluded patients who were delirious on the first day of ICU, those who were under sustained coma throughout their ICU stay, and those who stayed in the ICU less than 24 h. The discriminative ability of PRE-DELIRIC was evaluated by measuring the area under the receiver operating characteristic curve (AUROC).
Of the 201 patients enrolled in the trial, we analyzed 158 patients. The mean age was 69.4 ± 14.0 years, and 99 patients (63%) were men. Delirium occurred at least once during the ICU stay of 63 patients (40%). The AUROC of PRE-DELIRIC was 0.60 (95% confidence interval, 0.50-0.69). Subgroup analyses indicated that PRE-DELIRIC was useful in those with Sequential Organ Failure Assessment score >8 with AUROC of 0.65 (95% confidence interval, 0.51-0.77).
The PRE-DELIRIC model could not predict delirium in mechanically ventilated patients with sepsis.
脓毒症患者在重症监护病房（ICU）住院期间常发生谵妄，这与发病率和死亡率增加相关。一种用于ICU患者谵妄的预测模型PRE-DELIRIC已应用于所有ICU患者，但在脓毒症患者中的效用尚不确定。本研究旨在检验PRE-DELIRIC在预测机械通气脓毒症患者谵妄方面的效用。
这是一项对日本8个ICU进行的随机临床试验的事后分析，该试验旨在评估在成年机械通气脓毒症患者中使用/不使用右美托咪定的镇静策略。在患者整个ICU住院期间，每天使用ICU意识模糊评估方法来评估谵妄。我们排除了在ICU第一天就出现谵妄的患者、在整个ICU住院期间持续昏迷的患者以及在ICU住院时间少于24小时的患者。通过测量受试者工作特征曲线下面积（AUROC）来评估PRE-DELIRIC的辨别能力。
在该试验纳入的201例患者中，我们分析了158例患者。平均年龄为69.4±14.0岁，99例（63%）为男性。63例患者（40%）在ICU住院期间至少发生过一次谵妄。PRE-DELIRIC的AUROC为0.60（95%置信区间，0.50 - 0.69）。亚组分析表明，PRE-DELIRIC在序贯器官衰竭评估评分>8的患者中有用，AUROC为0.65（95%置信区间，0.51 - 0.77）。
PRE-DELIRIC模型无法预测机械通气脓毒症患者的谵妄。
