Department of Internal Medicine, Zuger Kantonsspital, Landhausstrasse 11, 6340, Baar, Switzerland.
Department of Medicine, Spital Limmattal, Urdorferstrasse 100, 8952, Schlieren, Switzerland.
Sci Rep. 2021 Sep 21;11(1):18756. doi: 10.1038/s41598-021-98200-8.
Delirium in the general intensive care unit (ICU) population is common, associated with adverse outcomes and well studied. However, knowledge on delirium in the increasing number of ICU patients with malignancy is scarce. The aim was to assess the frequency of delirium and its impact on resource utilizations and outcomes in ICU patients with malignancy. This retrospective, single-center longitudinal cohort study included all patients with malignancy admitted to ICUs of a University Hospital during one year. Delirium was diagnosed by an Intensive Care Delirium Screening Checklist (ICDSC) score ≥ 4. Of 488 ICU patients with malignancy, 176/488 (36%) developed delirium. Delirious patients were older (66 [55-72] vs. 61 [51-69] years, p = 0.001), had higher SAPS II (41 [27-68] vs. 24 [17-32], p < 0.001) and more frequently sepsis (26/176 [15%] vs. 6/312 [1.9%], p < 0.001) and/or shock (30/176 [6.1%] vs. 6/312 [1.9%], p < 0.001). In multivariate analysis, delirium was independently associated with lower discharge home (OR [95% CI] 0.37 [0.24-0.57], p < 0.001), longer ICU (HR [95% CI] 0.30 [0.23-0.37], p < 0.001) and hospital length of stay (HR [95% CI] 0.62 [0.50-0.77], p < 0.001), longer mechanical ventilation (HR [95% CI] 0.40 [0.28-0.57], p < 0.001), higher ICU nursing workload (B [95% CI] 1.92 [1.67-2.21], p < 0.001) and ICU (B [95% CI] 2.08 [1.81-2.38], p < 0.001) and total costs (B [95% CI] 1.44 [1.30-1.60], p < 0.001). However, delirium was not independently associated with in-hospital mortality (OR [95% CI] 2.26 [0.93-5.54], p = 0.074). In conclusion, delirium was a frequent complication in ICU patients with malignancy independently associated with high resource utilizations, however, it was not independently associated with in-hospital mortality.
在普通重症监护病房（ICU）人群中，谵妄很常见，与不良结局有关，并且研究得很充分。然而，在越来越多患有恶性肿瘤的 ICU 患者中，关于谵妄的知识却很少。目的是评估恶性肿瘤 ICU 患者中谵妄的发生率及其对资源利用和结局的影响。这是一项回顾性、单中心纵向队列研究，纳入了一家大学医院 ICU 中所有患有恶性肿瘤的患者。谵妄通过重症监护谵妄筛查检查表（ICDSC）评分≥4 来诊断。在 488 例患有恶性肿瘤的 ICU 患者中，176/488（36%）发生了谵妄。谵妄患者年龄更大（66 [55-72] 岁 vs. 61 [51-69] 岁，p=0.001），SAPS II 评分更高（41 [27-68] vs. 24 [17-32]，p<0.001），更常发生脓毒症（26/176 [15%] vs. 6/312 [1.9%]，p<0.001）和/或休克（30/176 [6.1%] vs. 6/312 [1.9%]，p<0.001）。多变量分析表明，谵妄与较低的出院回家率（OR [95%CI] 0.37 [0.24-0.57]，p<0.001）、较长的 ICU （HR [95%CI] 0.30 [0.23-0.37]，p<0.001）和住院时间（HR [95%CI] 0.62 [0.50-0.77]，p<0.001）、较长的机械通气时间（HR [95%CI] 0.40 [0.28-0.57]，p<0.001）、较高的 ICU 护理工作量（B [95%CI] 1.92 [1.67-2.21]，p<0.001）和 ICU （B [95%CI] 2.08 [1.81-2.38]，p<0.001）和总费用（B [95%CI] 1.44 [1.30-1.60]，p<0.001）独立相关。然而，谵妄与院内死亡率无关（OR [95%CI] 2.26 [0.93-5.54]，p=0.074）。总之，谵妄是恶性肿瘤 ICU 患者中常见的并发症，与高资源利用独立相关，但与院内死亡率无关。
