Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
Harvard Medical School, Boston, Massachusetts; Department of Internal Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Transplant Cell Ther. 2023 May;29(5):334.e1-334.e7. doi: 10.1016/j.jtct.2023.01.028. Epub 2023 Feb 1.
Delirium, a common neuropsychiatric syndrome among hospitalized patients, has been associated with significant morbidity and mortality in patients undergoing hematopoietic stem cell transplantation (HSCT). Although delirium is often reversible with prompt diagnosis and appropriate management, timely screening of hospitalized patients, including HSCT recipients at risk for delirium, is lacking. The association between delirium symptoms and healthcare utilization among HSCT recipients is also limited. We conducted a retrospective analysis of 502 hospitalized patients admitted for allogeneic or autologous HSCT at 2 tertiary care hospitals between April 2016 and April 2021. We used Natural Language Processing (NLP) to identify patients with delirium symptoms, as defined by an NLP-assisted chart review of the electronic health record (EHR). We used multivariable regression models to examine the associations between delirium symptoms, clinical outcomes, and healthcare utilization, adjusting for patient-, disease-, and transplantation-related factors. Overall, 44.4% (124 of 279) of patients undergoing allogeneic HSCT and 39.0% (87 of 223) of those undergoing autologous HSCT were identified as having delirium symptoms during their index hospitalization. Two-thirds (139 of 211) of the patients with delirium symptoms were prescribed treatment with antipsychotic medications. Among allogeneic HSCT recipients, delirium symptoms were associated with longer hospital length of stay (β = 7.960; P < .001), fewer days alive and out of the hospital (β = -23.669; P < .001), and more intensive care unit admissions (odds ratio, 2.854; P = .002). In autologous HSCT recipients, delirium symptoms were associated with longer hospital length of stay (β = 2.204; P < .001). NLP-assisted EHR review is a feasible approach to identifying hospitalized patients, including HSCT recipients at risk for delirium. Because delirium symptoms are negatively associated with health care utilization during and after HSCT, our findings underscore the need to efficiently identify patients hospitalized for HSCT who are at risk of delirium to improve their outcomes. © 2023 American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc.
谵妄是住院患者中常见的神经精神综合征，与造血干细胞移植 (HSCT) 患者的发病率和死亡率显著相关。尽管谵妄通过及时诊断和适当治疗通常是可逆的，但缺乏对包括 HSCT 受者在内的住院患者的及时筛查。HSCT 受者谵妄症状与医疗保健利用之间的关联也有限。我们对 2016 年 4 月至 2021 年 4 月期间在 2 家三级保健医院接受异基因或自体 HSCT 的 502 名住院患者进行了回顾性分析。我们使用自然语言处理 (NLP) 通过电子病历 (EHR) 的 NLP 辅助图表审查来识别谵妄症状患者。我们使用多变量回归模型，调整患者、疾病和移植相关因素后，检查谵妄症状与临床结局和医疗保健利用之间的关联。总体而言，44.4%（279 名患者中的 124 名）接受异基因 HSCT 的患者和 39.0%（223 名患者中的 87 名）接受自体 HSCT 的患者在其指数住院期间被确定为有谵妄症状。三分之二（139 名患者中的 139 名）有谵妄症状的患者被开了抗精神病药物治疗。在异基因 HSCT 受者中，谵妄症状与住院时间延长相关（β=7.960；P<.001），存活和出院天数减少（β=-23.669；P<.001），入住重症监护病房的次数增加（比值比，2.854；P=.002）。在自体 HSCT 受者中，谵妄症状与住院时间延长相关（β=2.204；P<.001）。NLP 辅助的 EHR 审查是一种识别包括 HSCT 受者在内的谵妄高危住院患者的可行方法。由于谵妄症状与 HSCT 期间和之后的医疗保健利用呈负相关，我们的研究结果强调需要有效地识别因 HSCT 住院的有谵妄风险的患者，以改善他们的结局。
