Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine (C.M.Z., R.v.K.), University of Zurich, University Hospital Zurich, Switzerland.
Department of Neurology and Neurophysiology, University of Zurich, Balgrist University Hospital, Switzerland (C.M.Z.).
Stroke. 2021 Oct;52(10):3325-3334. doi: 10.1161/STROKEAHA.120.033005. Epub 2021 Jul 8.
Delirium is a common severe complication of stroke. We aimed to determine the cost-of-illness and risk factors of poststroke delirium (PSD).
This prospective single-center study included n=567 patients with acute stroke from a hospital-wide delirium cohort study and the Swiss Stroke Registry in 2014. Delirium was determined by Delirium Observation Screening Scale or Intensive Care Delirium Screening Checklist 3 times daily during the first 3 days of admission. Costs reflected the case-mix index and diagnosis-related groups from 2014 and were divided into nursing, physician, and total costs. Factors associated with PSD were assessed with multiple regression analysis. Partial correlations and quantile regression were performed to assess costs and other factors associated with PSD.
The incidence of PSD was 39.0% (221/567). Patients with delirium were older than non-PSD (median 76 versus 70 years; P<0.001), 52% male (115/221) versus 62% non-PSD (214/346) and hospitalized longer (mean 11.5 versus 9.3 days; P<0.001). Dementia was the most relevant predisposing factor for PSD (odds ratio, 16.02 [2.83–90.69], P=0.002). Moderate to severe stroke (National Institutes of Health Stroke Scale score 16–20) was the most relevant precipitating factor (odds ratio, 36.10 [8.15–159.79], P<0.001). PSD was a strong predictor for 3-month mortality (odds ratio, 15.11 [3.33–68.53], P<0.001). Nursing and total costs were nearly twice as high in PSD (P<0.001). There was a positive correlation between total costs and admission National Institutes of Health Stroke Scale (correlation coefficient, 0.491; P<0.001) and length of stay (correlation coefficient, 0.787; P<0.001) in all patients. Quantile regression revealed rising nursing and total costs associated with PSD, higher National Institutes of Health Stroke Scale, and longer hospital stay (all P<0.05).
PSD was associated with greater stroke severity, prolonged hospitalization, and increased nursing and total costs. In patients with severe stroke, dementia, or seizures, PSD is anticipated, and additional costs are associated with hospitalization.
谵妄是中风的一种常见严重并发症。本研究旨在确定中风后谵妄（PSD）的疾病经济负担和相关风险因素。
本前瞻性单中心研究纳入了 2014 年来自一项全医院谵妄队列研究和瑞士卒中登记处的 567 例急性卒中患者。在入院后的头 3 天内，使用谵妄观察筛查量表或重症监护谵妄筛查检查表每日 3 次来确定谵妄。费用反映了 2014 年的病例组合指数和诊断相关分组，并分为护理、医师和总费用。采用多元回归分析评估与 PSD 相关的因素。进行偏相关分析和分位数回归以评估与 PSD 相关的费用和其他因素。
PSD 的发生率为 39.0%（221/567）。与非 PSD 患者相比，谵妄患者年龄更大（中位数 76 岁比 70 岁；P<0.001），52%为男性（115/221）而非 PSD 患者为 62%（214/346），且住院时间更长（平均 11.5 天比 9.3 天；P<0.001）。痴呆是 PSD 最相关的易患因素（优势比，16.02[2.83–90.69]，P=0.002）。中重度卒中（NIHSS 评分 16-20 分）是最相关的促发因素（优势比，36.10[8.15–159.79]，P<0.001）。PSD 是 3 个月死亡率的强烈预测因素（优势比，15.11[3.33–68.53]，P<0.001）。PSD 患者的护理和总费用几乎高出两倍（P<0.001）。在所有患者中，总费用与入院 NIHSS（相关系数，0.491；P<0.001）和住院时间（相关系数，0.787；P<0.001）呈正相关。分位数回归显示，与 PSD 相关的护理和总费用增加、NIHSS 评分更高和住院时间更长（均 P<0.05）。
PSD 与更严重的卒中、延长的住院时间以及增加的护理和总费用相关。在严重卒中、痴呆或癫痫患者中，预计会发生 PSD，并与住院相关的费用增加。
