Zipser Carl Moritz, Hildenbrand Florian Freimut, Haubner Bernhard, Deuel Jeremy, Ernst Jutta, Petry Heidi, Schubert Maria, Jordan Katja-Daniela, von Känel Roland, Boettger Soenke
Consultation-Liaison Psychiatry and Psychosomatic Medicine, University of Zurich, University Hospital Zurich, Zurich, Switzerland.
Department of Neurology and Neurophysiology, University of Zurich, Balgrist University Hospital, Zurich, Switzerland.
Front Cardiovasc Med. 2021 Sep 29;8:686665. doi: 10.3389/fcvm.2021.686665. eCollection 2021.
Although the risk factors for delirium in general medicine are well-established, their significance in cardiac diseases remains to be determined. Therefore, we evaluated the predisposing and precipitating risk factors in patients hospitalized with acute and chronic heart disease. In this observational cohort study, 1,042 elderly patients (≥65 years) admitted to cardiology wards, 167 with and 875 without delirium, were included. The relevant sociodemographic and cardiac- and medical-related clusters were assessed by simple and multiple regression analyses and prediction models evaluating their association with delirium. The prevalence of delirium was 16.0%. The delirious patients were older (mean 80 vs. 76 years; < 0.001) and more often institutionalized prior to admission (3.6 vs. 1.4%, = 0.05), hospitalized twice as long (12 ± 10 days vs. 7 ± 7 days; < 0.001), and discharged more often to nursing homes (4.8 vs. 0.6%, < 0.001) or deceased (OR, 2.99; 95% CI, 1.53-5.85; = 0.003). The most relevant risk factor was dementia (OR, 18.11; 95% CI, 5.77-56.83; < 0.001), followed by history of stroke (OR, 6.61; 95% CI 1.35-32.44; = 0.020), and pressure ulcers (OR, 3.62; 95% CI, 1.06-12.35; = 0.040). The predicted probability for developing delirium was highest in patients with reduced mobility and institutionalization prior to admission (PP = 31.2%, = 0.001). Of the cardiac diseases, only valvular heart disease (OR, 1.57; 95% CI, 1.01-2.44; = 0.044) significantly predicted delirium. The patients undergoing cardiac interventions did not have higher rates of delirium (OR, 1.39; 95% CI 0.91-2.12; = 0.124). In patients admitted to a cardiology ward, age-related functional and cognitive impairment, history of stroke, and pressure ulcers were the most relevant risk factors for delirium. With regards to specific cardiological factors, only valvular heart disease was associated with risk for delirium. Knowing these factors can help cardiologists to facilitate the early detection and management of delirium.
尽管普通内科中谵妄的危险因素已得到充分证实，但其在心脏疾病中的意义仍有待确定。因此，我们评估了急性和慢性心脏病住院患者的诱发和促发危险因素。在这项观察性队列研究中，纳入了1042名入住心脏病病房的老年患者（≥65岁），其中167名患有谵妄，875名未患谵妄。通过简单和多元回归分析以及评估其与谵妄关联的预测模型，对相关的社会人口统计学以及心脏和医学相关因素进行了评估。谵妄的患病率为16.0%。患谵妄的患者年龄更大（平均80岁对76岁；<0.001），入院前更多人入住养老院（3.6%对1.4%，=0.05），住院时间延长一倍（12±10天对7±7天；<0.001），出院后更多人入住疗养院（4.8%对0.6%，<0.001）或死亡（OR，2.99；95%CI，1.53 - 5.85；=0.003）。最相关的危险因素是痴呆（OR，18.11；95%CI，5.77 - 56.83；<0.001），其次是中风史（OR，6.61；95%CI 1.35 - 32.44；=0.020）和压疮（OR，3.62；95%CI，1.06 - 12.35；=0.040）。入院前活动能力下降和入住养老院的患者发生谵妄的预测概率最高（PP = 31.2%，=0.001）。在心脏疾病中，只有瓣膜性心脏病（OR，1.57；95%CI，1.01 - 2.44；=0.044）显著预测谵妄。接受心脏介入治疗的患者谵妄发生率并未更高（OR，1.39；95%CI 0.91 - 2.12；=0.124）。在入住心脏病病房的患者中，与年龄相关的功能和认知障碍、中风史和压疮是谵妄最相关的危险因素。关于特定的心脏因素，只有瓣膜性心脏病与谵妄风险相关。了解这些因素有助于心脏病专家促进谵妄的早期发现和管理。
