重症监护病房老年患者谵妄作为独立死亡风险因素的发生率及交互作用因素：来自 MIMIC-IV 数据库的回顾性分析。
Incidence and interaction factors of delirium as an independent risk of mortality in elderly patients in the intensive units: a retrospective analysis from MIMIC-IV database.
机构信息
Department of Critical Care Medicine, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China.
Department of Diagnosis and Treatment of Cadres, 1st Medical Center, Chinese PLA General Hospital, Beijing, China.
出版信息
Aging Clin Exp Res. 2022 Nov;34(11):2865-2872. doi: 10.1007/s40520-022-02215-8. Epub 2022 Sep 3.
BACKGROUND
As delirium is a common problem in critcal elderly patients, the aim of the study was to investigate the interaction factors of delirium as an independent risk of mortality in elderly patients in the intensive care unit (ICU).
PATIENTS AND METHODS
Elderly patients (age ≥ 65) were selected from Medical Information Mart for Intensive Care (MIMIC)-IV database. Demographics data were collected on the 1st day of admission to ICU. The main outcome is in-hospital mortality. Propensity score matching analysis (PSMA) was used to remove the influence of comfounding factors between survival and nonsurvival groups. Chi-square test and logistic regression analysis was used to identify the association between delirium and in-hospital death. Stratified analysis and interaction analysis was used to evaluate the interaction factors of delirium as a risk of in-hospital mortality.
RESULTS
22,361 patients were selected, and in which 2809 patients died. 5453 patients had delirium (about 24.4%). There is a significant difference in delirium between the survival and nonsurvival groups before and after PSMA (p = 0.000 and p = 0.030). Logistic regression showed delirium, sequential organ failure assessment (SOFA), and hemoglobin were all significantly related to in-hospital death (p = 0.000). SOFA score and hemoglobin concentration were proved to be remarkable interaction factors of delirium (p = 0.000, and p = 0.041). Significant correlation between delirium and hospital mortality was inhibited when SOFA was more than 12 or hemoglobin was higher than 15 g/dL. In-hospital mortality (49.1% vs. 10.5%, p = 0.000) and shock incidence (87.9% vs. 15.8%, p = 0.000) of the patients with SOFA ≥ 12 was much higher than that of the patients with SOFA ≤ 11.
CONCLUSION
SOFA and hemoglobin are interaction factors of delirium as an independent risk of in-hospital mortality in elderly patients in the intensive care unit.
背景
由于谵妄是危重症老年患者的常见问题，本研究旨在探讨谵妄作为 ICU 老年患者死亡的独立危险因素的交互因素。
方法
从 Medical Information Mart for Intensive Care (MIMIC)-IV 数据库中选择年龄≥65 岁的老年患者。收集患者入住 ICU 第 1 天的人口统计学数据。主要结局为院内死亡率。采用倾向评分匹配分析（PSMA）消除生存组和非生存组之间混杂因素的影响。采用卡方检验和逻辑回归分析确定谵妄与院内死亡的关系。采用分层分析和交互分析评价谵妄作为院内死亡风险的交互因素。
结果
共纳入 22361 例患者，其中 2809 例患者死亡。5453 例患者发生谵妄（约 24.4%）。PSMA 前后，生存组和非生存组之间谵妄发生率差异有统计学意义（p=0.000 和 p=0.030）。逻辑回归显示，谵妄、序贯器官衰竭评估（SOFA）和血红蛋白均与院内死亡显著相关（p=0.000）。SOFA 评分和血红蛋白浓度被证实是谵妄的显著交互因素（p=0.000 和 p=0.041）。当 SOFA 大于 12 或血红蛋白大于 15 g/dL 时，谵妄与住院死亡率之间的显著相关性受到抑制。SOFA≥12 的患者的院内死亡率（49.1% vs. 10.5%，p=0.000）和休克发生率（87.9% vs. 15.8%，p=0.000）明显高于 SOFA≤11 的患者。
结论
SOFA 和血红蛋白是谵妄作为 ICU 老年患者死亡的独立危险因素的交互因素。
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