Miao Lei, Shen Xiaozhu, Du Zhiqiang, Liao Jingxian
Department of Critical Care Medicine, the Second People's Hospital of Lianyungang, Lianyungang 222000, Jiangsu, China.
Department of Geriatrics, the Second People's Hospital of Lianyungang, Lianyungang 222000, Jiangsu, China. Corresponding author: Liao Jingxian, Email:
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2023 Oct;35(10):1053-1057. doi: 10.3760/cma.j.cn121430-20230303-00140.
To investigate the relationship between malnutrition and delirium and its effect on prognosis in elderly patients with severe pneumonia undergoing invasive mechanical ventilation.
A prospective observational study was conducted. Patients with severe pneumonia aged ≥ 60 years old who underwent invasive mechanical ventilation admitted to department of critical care medicine of the Second People's Hospital of Lianyungang from January 2021 to December 2022 were enrolled. The confusion assessment method (CAM) was used to evaluate the delirium of the patients in intensive care unit (ICU). The score of CAM ≥ 1 was defined as delirium. Mini nutritional assessment short-form (MNA-SF) was used to assess the nutritional status of patients, and MNA-SF score ≤ 7 was defined as malnutrition. Patients were divided into delirium group and non-delirium group according to whether delirium occurred. The differences in clinical indicators, length of ICU stay, duration of mechanical ventilation and wake-up time after drug withdrawal were compared between the two groups. After 28 days of short-term follow-up, the patients were divided into death group and survival group, and the differences in the incidence of delirium and malnutrition between the two groups were compared. Binary multivariate Logistic regression analysis was used to screen the risk factors for delirium in elderly patients with severe pneumonia undergoing invasive mechanical ventilation. Kaplan-Meier survival curve was used to analyze the effect of delirium on prognosis.
A total of 132 elderly patients with severe pneumonia undergoing invasive mechanical ventilation were enrolled, of whom 98 survived and 34 died within 28 days, with a mortality of 25.76%. The incidence of malnutrition and delirium in the death group was significantly higher than that in the survival group (61.76% vs. 37.76%, 64.71% vs. 26.53%, both P < 0.05), and the MNA-SF score was significantly lower than that in the survival group (6.32±1.80 vs. 8.72±2.23, P < 0.01). Procalcitonin (PCT), interleukin-6 (IL-6) and blood lactic acid (Lac) in the death group were significantly higher than those in the survival group [PCT (μg/L): 4.47 (2.69, 10.39) vs. 2.77 (1.28, 5.94), IL-6 (ng/L): 204.08 (126.12, 509.85) vs. 120.46 (60.67, 290.99), Lac (mmol/L): 5.14 (2.75, 8.60) vs. 3.13 (2.16, 4.30), all P < 0.05], and the wake-up time after drug withdrawal was significantly longer than that in the survival group (minutes: 33.94±8.51 vs. 28.92±7.03, P < 0.01). Among 132 elderly patients with severe pneumonia undergoing invasive mechanical ventilation, 48 patients had delirium during ICU stay, and 84 patients did not have delirium. The incidence of delirium was 36.36%. The 28-day mortality in the delirium group was significantly higher than that in the non-delirium group (45.83% vs. 14.29%, P < 0.01), and the MNA-SF score was significantly lower than that in the non-delirium group (6.46±1.77 vs. 9.05±2.15, P < 0.01), the length of ICU stay, duration of mechanical ventilation, and wake-up time after drug withdrawal were also significantly longer than those in the non-delirium group [length of ICU stay (days): 13.40±9.59 vs. 10.06±7.81, duration of mechanical ventilation (hours): 197.06±89.80 vs. 138.81±82.30, wake-up time after drug withdrawal (minutes): 35.85±7.01 vs. 26.99±6.12, all P < 0.05]. Binary multivariate Logistic regression analysis showed that malnutrition [odds ratio (OR) = 7.527, 95% confidence interval (95%CI) was 2.585-21.917], Lac (OR = 5.345, 95%CI was 1.733-16.483), wake-up time after drug withdrawal (OR = 6.653, 95%CI was 2.021-21.904) were independent risk factors for delirium during ICU stay in elderly patients with severe pneumonia undergoing invasive mechanical ventilation (all P < 0.01). Kaplan-Meier survival analysis showed that the 28-day cumulative survival rate of patients in the delirium group was significantly lower than that in the non-delirium group (54.17% vs. 85.71%), and the difference was statistically significant (Log-Rank test: χ = 16.780, P < 0.001).
The risk factors for delirium in elderly patients with severe pneumonia undergoing invasive mechanical ventilation during ICU stay include malnutrition, Lac, and wake-up time after drug withdrawal. The occurrence of delirium is closely related to poor prognosis.
探讨老年重症肺炎有创机械通气患者营养不良与谵妄的关系及其对预后的影响。
进行一项前瞻性观察性研究。纳入2021年1月至2022年12月在连云港市第二人民医院重症医学科住院的年龄≥60岁的重症肺炎有创机械通气患者。采用意识模糊评估法（CAM）评估重症监护病房（ICU）患者的谵妄情况。CAM评分≥1分为谵妄。采用微型营养评定简表（MNA-SF）评估患者营养状况，MNA-SF评分≤7分为营养不良。根据是否发生谵妄将患者分为谵妄组和非谵妄组。比较两组患者的临床指标、ICU住院时间、机械通气时间及撤机后苏醒时间。短期随访28天后，将患者分为死亡组和存活组，比较两组谵妄和营养不良的发生率。采用二元多因素Logistic回归分析筛选老年重症肺炎有创机械通气患者谵妄的危险因素。采用Kaplan-Meier生存曲线分析谵妄对预后的影响。
共纳入132例老年重症肺炎有创机械通气患者，其中98例存活，34例在28天内死亡，死亡率为25.76%。死亡组营养不良和谵妄的发生率均显著高于存活组（61.76%比37.76%，64.71%比26.53%，均P<0.05），且MNA-SF评分显著低于存活组（6.32±1.80比8.72±2.23，P<0.01）。死亡组降钙素原（PCT）、白细胞介素-6（IL-6）和血乳酸（Lac）水平均显著高于存活组[PCT（μg/L）：4.47（2.69，10.39）比2.77（1.28，5.94），IL-6（ng/L）：204.08（126.12，509.85）比120.46（60.67，290.99），Lac（mmol/L）：5.14（2.75，8.60）比3.13（2.16，4.30），均P<0.05]，撤机后苏醒时间显著长于存活组（分钟：33.94±8.51比28.92±7.03，P<0.01）。132例老年重症肺炎有创机械通气患者中，48例在ICU住院期间发生谵妄，84例未发生谵妄。谵妄发生率为36.36%。谵妄组28天死亡率显著高于非谵妄组（45.83%比14.29%，P<0.01），且MNA-SF评分显著低于非谵妄组（6.46±1.77比9.05±2.15，P<0.01），ICU住院时间、机械通气时间及撤机后苏醒时间也显著长于非谵妄组[ICU住院时间（天）：13.40±9.59比10.06±7.81，机械通气时间（小时）：197.06±89.80比138.81±82.30，撤机后苏醒时间（分钟）：35.85±7.01比26.99±6.12，均P<0.05]。二元多因素Logistic回归分析显示，营养不良[比值比（OR）=7.527，95%置信区间（95%CI）为2.585-21.917]、Lac（OR=5.345，95%CI为1.733-16.483）、撤机后苏醒时间（OR=6.653，95%CI为2.021-21.904）是老年重症肺炎有创机械通气患者ICU住院期间谵妄的独立危险因素（均P<0.01）。Kaplan-Meier生存分析显示，谵妄组患者28天累积生存率显著低于非谵妄组（54.17%比85.71%），差异有统计学意义（Log-Rank检验：χ=16.780，P<0.001）。
老年重症肺炎有创机械通气患者ICU住院期间谵妄的危险因素包括营养不良、Lac及撤机后苏醒时间。谵妄的发生与预后不良密切相关。
