Department of Neurology, Massachusetts General Hospital, Boston, MA, United States of America.
Harvard Medical School, Boston, MA, United States of America.
PLoS One. 2021 Dec 2;16(12):e0259840. doi: 10.1371/journal.pone.0259840. eCollection 2021.
We investigated the effect of delirium burden in mechanically ventilated patients, beginning in the ICU and continuing throughout hospitalization, on functional neurologic outcomes up to 2.5 years following critical illness.
Prospective cohort study of enrolling 178 consecutive mechanically ventilated adult medical and surgical ICU patients between October 2013 and May 2016. Altogether, patients were assessed daily for delirium 2941days using the Confusion Assessment Method for the ICU (CAM-ICU). Hospitalization delirium burden (DB) was quantified as number of hospital days with delirium divided by total days at risk. Survival status up to 2.5 years and neurologic outcomes using the Glasgow Outcome Scale were recorded at discharge 3, 6, and 12 months post-discharge.
Of 178 patients, 19 (10.7%) were excluded from outcome analyses due to persistent coma. Among the remaining 159, 123 (77.4%) experienced delirium. DB was independently associated with >4-fold increased mortality at 2.5 years following ICU admission (adjusted hazard ratio [aHR], 4.77; 95% CI, 2.10-10.83; P < .001), and worse neurologic outcome at discharge (adjusted odds ratio [aOR], 0.02; 0.01-0.09; P < .001), 3 (aOR, 0.11; 0.04-0.31; P < .001), 6 (aOR, 0.10; 0.04-0.29; P < .001), and 12 months (aOR, 0.19; 0.07-0.52; P = .001). DB in the ICU alone was not associated with mortality (HR, 1.79; 0.93-3.44; P = .082) and predicted neurologic outcome less strongly than entire hospital stay DB. Similarly, the number of delirium days in the ICU and for whole hospitalization were not associated with mortality (HR, 1.00; 0.93-1.08; P = .917 and HR, 0.98; 0.94-1.03, P = .535) nor with neurological outcomes, except for the association between ICU delirium days and neurological outcome at discharge (OR, 0.90; 0.81-0.99, P = .038).
Delirium burden throughout hospitalization independently predicts long term neurologic outcomes and death up to 2.5 years after critical illness, and is more predictive than delirium burden in the ICU alone and number of delirium days.
我们研究了机械通气患者在 ICU 期间和住院期间的谵妄负担对重症后 2.5 年内神经功能结局的影响。
这是一项前瞻性队列研究，纳入了 2013 年 10 月至 2016 年 5 月期间的 178 名连续接受机械通气的成年内科和外科 ICU 患者。使用 ICU 意识模糊评估法（CAM-ICU）对患者进行每日谵妄评估，共 2941 天。住院谵妄负担（DB）通过谵妄天数除以总风险天数来量化。出院后 3、6 和 12 个月时记录患者的存活状态和使用格拉斯哥结局量表（GOS）的神经功能结局。
在 178 名患者中，有 19 名（10.7%）因持续昏迷而被排除在结局分析之外。在其余 159 名患者中，有 123 名（77.4%）发生了谵妄。DB 与 ICU 入住后 2.5 年内死亡率增加 4 倍以上独立相关（调整后的危险比[aHR]，4.77；95%CI，2.10-10.83；P<.001），并且与出院时神经功能结局较差独立相关（调整后的优势比[aOR]，0.02；0.01-0.09；P<.001）、3 个月（aOR，0.11；0.04-0.31；P<.001）、6 个月（aOR，0.10；0.04-0.29；P<.001）和 12 个月（aOR，0.19；0.07-0.52；P=0.001）。ICU 中的谵妄负担与死亡率（HR，1.79；0.93-3.44；P=0.082）无关，并且预测神经功能结局的能力不如整个住院期间的 DB 强。同样，ICU 中的谵妄天数和整个住院期间的谵妄天数与死亡率（HR，1.00；0.93-1.08；P=0.917 和 HR，0.98；0.94-1.03，P=0.535）或神经功能结局均无关，除了 ICU 谵妄天数与出院时神经功能结局的关联（OR，0.90；0.81-0.99，P=0.038）。
住院期间的谵妄负担独立预测重症后 2.5 年内的长期神经功能结局和死亡，并且比 ICU 中的谵妄负担和谵妄天数更具预测性。
