Clinical Pharmacy, Department Medical Services, Cantonal Hospital of Baden, Baden, Switzerland.
Center for Research and Innovation in Clinical Pharmaceutical Sciences, University Hospital and University of Lausanne, Lausanne, Switzerland.
Br J Clin Pharmacol. 2022 Nov;88(11):4915-4927. doi: 10.1111/bcp.15432. Epub 2022 Jun 25.
A recent review identified 19 anticholinergic burden scales (ABSs) but no study has yet compared the impact of all 19 ABSs on delirium. We evaluated whether a high anticholinergic burden as classified by each ABS is associated with incident delirium.
We performed a retrospective cohort study in a Swiss tertiary teaching hospital using data from 2015-2018. Included were patients aged ≥65, hospitalised ≥48 hours with no stay >24 hours in intensive care. Delirium was defined twofold: (i) ICD-10 or CAM and (ii) ICD-10 or CAM or DOSS. Patients' cumulative anticholinergic burden score, calculated within 24 hours after admission, was classified using a binary (<3: low, ≥3: high burden) and a categorical approach (0: no, 0.5-3: low, ≥3: high burden). Association was analysed using multivariable logistic regression.
Over 25 000 patients (mean age 77.9 ± 7.6 years) were included. Of these, (i) 864 (3.3%) and (ii) 2770 (11.0%) developed delirium. Depending on the evaluated ABS, 4-63% of the patients were exposed to at least one anticholinergic drug. Out of 19 ABSs, (i) 14 and (ii) 16 showed a significant association with the outcomes. A patient with a high anticholinergic burden score had odds ratios (ORs) of 1.21 (95% confidence interval [CI]: 1.03-1.42) to 2.63 (95% CI: 2.28-3.03) for incident delirium compared to those with low or no burden.
A high anticholinergic burden within 24 hours after admission was significantly associated with incident delirium. Although prospective studies need to confirm these results, discontinuing or substituting drugs with a score of ≥3 at admission might be a targeted intervention to reduce incident delirium.
最近的一篇综述确定了 19 种抗胆碱能负担量表（ABS），但尚无研究比较所有 19 种 ABS 对谵妄的影响。我们评估了每种 ABS 分类的高抗胆碱能负担是否与谵妄的发生有关。
我们在瑞士一家三级教学医院进行了回顾性队列研究，使用了 2015-2018 年的数据。纳入标准为年龄≥65 岁，住院时间≥48 小时，重症监护病房停留时间不超过 24 小时。谵妄的定义有两种：（i）ICD-10 或 CAM 和（ii）ICD-10 或 CAM 或 DOSS。在入院后 24 小时内计算患者的累积抗胆碱能负担评分，使用二分类（<3：低，≥3：高负担）和分类方法（0：无，0.5-3：低，≥3：高负担）进行分类。使用多变量逻辑回归分析相关性。
共有超过 25000 名患者（平均年龄 77.9±7.6 岁）纳入研究。其中（i）864 名（3.3%）和（ii）2770 名（11.0%）发生了谵妄。根据评估的 ABS，4-63%的患者至少使用了一种抗胆碱能药物。在 19 种 ABS 中，（i）有 14 种和（ii）有 16 种与结果有显著相关性。与低负担或无负担的患者相比，抗胆碱能负担评分高的患者发生谵妄的比值比（OR）为 1.21（95%置信区间[CI]：1.03-1.42）至 2.63（95% CI：2.28-3.03）。
入院后 24 小时内的高抗胆碱能负担与谵妄的发生显著相关。尽管需要前瞻性研究来证实这些结果，但在入院时停止或替代评分≥3 的药物可能是降低谵妄发生率的一种有针对性的干预措施。
