Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, United States of America.
Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America.
PLoS One. 2021 Apr 8;16(4):e0249097. doi: 10.1371/journal.pone.0249097. eCollection 2021.
To identify risk factors for delirium among hospitalized patients in Zambia.
We conducted a prospective cohort study at the University Teaching Hospital in Lusaka, Zambia, from October 2017 to April 2018. We report associations of exposures including sociodemographic and clinical factors with delirium over the first three days of hospital admission, assessed using a modified Brief Confusion Assessment Method (bCAM).
749 patients were included for analysis (mean age, 42.9 years; 64.8% men; 47.3% with HIV). In individual regression analyses of potential delirium risk factors adjusted for age, sex and education, factors significantly associated with delirium included being divorced/widowed (OR 1.64, 95% CI 1.09-2.47), lowest tercile income (OR 1.58, 95% CI 1.04-2.40), informal employment (OR 1.97, 95% CI 1.25-3.15), untreated HIV infection (OR 2.18, 95% CI 1.21-4.06), unknown HIV status (OR 2.90, 95% CI 1.47-6.16), history of stroke (OR 2.70, 95% CI 1.15-7.19), depression/anxiety (OR 1.52, 95% CI 1.08-2.14), alcohol overuse (OR 1.96, 95% CI 1.39-2.79), sedatives ordered on admission (OR 3.77, 95% CI 1.70-9.54), severity of illness (OR 2.00, 95% CI 1.82-2.22), neurological (OR 7.66, 95% CI 4.90-12.24) and pulmonary-system admission diagnoses (OR 1.91, 95% CI 1.29-2.85), and sepsis (OR 2.44, 95% CI 1.51-4.08). After combining significant risk factors into a multivariable regression analysis, severity of illness, history of stroke, and being divorced/widowed remained predictive of delirium (p<0.05).
Among hospitalized adults at a national referral hospital in Zambia, severity of illness, history of stroke, and being divorced/widowed were independently predictive of delirium. Extension of this work will inform future efforts to prevent, detect, and manage delirium in low- and middle-income countries.
确定赞比亚住院患者发生谵妄的风险因素。
我们在赞比亚卢萨卡的教学医院进行了一项前瞻性队列研究，时间为 2017 年 10 月至 2018 年 4 月。我们使用改良的Brief Confusion Assessment Method（bCAM）评估了在入院后的头三天内与谵妄相关的暴露因素，包括社会人口统计学和临床因素。
共纳入 749 例患者进行分析（平均年龄 42.9 岁；64.8%为男性；47.3%感染了 HIV）。在调整年龄、性别和教育程度的潜在谵妄风险因素的个体回归分析中，与谵妄显著相关的因素包括离婚/丧偶（OR 1.64，95%CI 1.09-2.47）、收入最低三分之一（OR 1.58，95%CI 1.04-2.40）、非正规就业（OR 1.97，95%CI 1.25-3.15）、未经治疗的 HIV 感染（OR 2.18，95%CI 1.21-4.06）、HIV 状态未知（OR 2.90，95%CI 1.47-6.16）、中风史（OR 2.70，95%CI 1.15-7.19）、抑郁/焦虑（OR 1.52，95%CI 1.08-2.14）、酒精过度使用（OR 1.96，95%CI 1.39-2.79）、入院时开镇静剂（OR 3.77，95%CI 1.70-9.54）、疾病严重程度（OR 2.00，95%CI 1.82-2.22）、神经（OR 7.66，95%CI 4.90-12.24）和肺部系统入院诊断（OR 1.91，95%CI 1.29-2.85），以及脓毒症（OR 2.44，95%CI 1.51-4.08）。将显著的风险因素结合到多变量回归分析中后，疾病严重程度、中风史和离婚/丧偶仍然是谵妄的预测因素（p<0.05）。
在赞比亚一家国立转诊医院的住院成年患者中，疾病严重程度、中风史和离婚/丧偶与谵妄独立相关。这项工作的扩展将为预防、发现和管理低收入和中等收入国家的谵妄提供信息。
