Department of Emergency Medicine, University of California, San Francisco.
Department of Neurology, University of California, San Francisco.
JAMA Netw Open. 2023 Jan 3;6(1):e2249950. doi: 10.1001/jamanetworkopen.2022.49950.
Despite discrete etiologies leading to delirium, it is treated as a common end point in hospital and in clinical trials, and delirium research may be hampered by the attempt to treat all instances of delirium similarly, leaving delirium management as an unmet need. An individualized approach based on unique patterns of delirium pathophysiology, as reflected in predisposing factors and precipitants, may be necessary, but there exists no accepted method of grouping delirium into distinct etiologic subgroups.
To conduct a systematic review to identify potential predisposing and precipitating factors associated with delirium in adult patients agnostic to setting.
A literature search was performed of PubMed, Embase, Web of Science, and PsycINFO from database inception to December 2021 using search Medical Subject Headings (MeSH) terms consciousness disorders, confusion, causality, and disease susceptibility, with constraints of cohort or case-control studies. Two reviewers selected studies that met the following criteria for inclusion: published in English, prospective cohort or case-control study, at least 50 participants, delirium assessment in person by a physician or trained research personnel using a reference standard, and results including a multivariable model to identify independent factors associated with delirium.
A total of 315 studies were included with a mean (SD) Newcastle-Ottawa Scale score of 8.3 (0.8) out of 9. Across 101 144 patients (50 006 [50.0%] male and 49 766 [49.1%] female patients) represented (24 015 with delirium), studies reported 33 predisposing and 112 precipitating factors associated with delirium. There was a diversity of factors associated with delirium, with substantial physiological heterogeneity.
In this systematic review, a comprehensive list of potential predisposing and precipitating factors associated with delirium was found across all clinical settings. These findings may be used to inform more precise study of delirium's heterogeneous pathophysiology and treatment.
尽管导致谵妄的病因不同，但它在医院和临床试验中都被视为一个共同的终点，并且由于试图以类似的方式治疗所有谵妄病例，谵妄研究可能会受到阻碍，导致谵妄的治疗仍然是一个未满足的需求。基于谵妄病理生理学的独特模式，例如易患因素和诱发因素，可能需要采取个体化的方法，但目前还没有一种公认的方法可以将谵妄分为不同的病因亚组。
进行系统评价，以确定与成人患者谵妄相关的潜在易患因素和诱发因素，而不考虑环境。
从数据库建立到 2021 年 12 月，使用 PubMed、Embase、Web of Science 和 PsycINFO 进行文献检索，使用了意识障碍、意识模糊、因果关系和疾病易感性等医学主题词 (MeSH) 术语，并对队列或病例对照研究进行了限制。两位审查员选择了符合以下纳入标准的研究：以英文发表、前瞻性队列或病例对照研究、至少 50 名参与者、由医生或经过培训的研究人员使用参考标准进行的人为主观谵妄评估、以及结果包括多变量模型以确定与谵妄相关的独立因素。
共纳入 315 项研究，纽卡斯尔-渥太华量表评分平均（SD）为 8.3（0.8）/9 分。共有 101440 名患者（50006 名[50.0%]男性和 49766 名[49.1%]女性）接受了评估（24015 名患有谵妄），研究报告了 33 个易患因素和 112 个诱发因素与谵妄相关。与谵妄相关的因素多种多样，存在很大的生理异质性。
在这项系统评价中，在所有临床环境中发现了与谵妄相关的潜在易患因素和诱发因素的综合清单。这些发现可以用于更精确地研究谵妄的异质性病理生理学和治疗方法。
