Li Xinya, Tang Yonglan, Bai Zihong, Liang Xin, Huang Xiaxuan, Chen Jianguang, Cheng Hongtao, Lyu Jun, Wang Yu
School of Nursing, Jinan University, Guangzhou, China.
Department of Neurology, The First Affiliated Hospital of Jinan University, Guangzhou, China.
J Clin Nurs. 2024 Oct 11. doi: 10.1111/jocn.17476.
To provide a viable tool for the early clinical identification of high-risk populations in patients with sepsis.
Sepsis-associated delirium (SAD) has the potential to significantly impact the short- and long-term prognosis of patients. However, accurately predicting and effectively managing SAD remains a significant challenge.
This study employed a retrospective analysis of adult sepsis patients admitted to the intensive care unit (ICU) for the first time. Patients were divided into two groups based on their initial Braden score upon admission to the ICU: a high-risk group (≤ 15 points) and a low-risk group (> 15 points). The relationship between Braden score and delirium was assessed using logistic regression and restricted cubic splines, while restricted mean survival time was employed to analyse the relationship between Braden scores and patients' 90- and 180-day mortality.
Of the 28,312 patients included in the study, those in the high-risk group exhibited a significantly elevated risk of delirium (44.8% vs. 29.7%) and higher 90-day (28.7% vs. 19.4%) and 180-day (33.2% vs. 24.1%) mortality rates (all p < 0.001). After adjusting for confounding variables, logistic regression demonstrated that the risk of delirium was 1.54 times higher in the high-risk group (95% CI = 1.45-1.64, p < 0.001). Following propensity score matching, the difference in survival was statistically significant at both time points, with the high-risk group having a reduced survival rate of 7.50 days (95% CI = -8.24, -6.75; p < 0.001) and 15.74 days (95% CI = -17.40, -14.08; p < 0.001) at 90 days and 180 days, respectively.
The Braden score is a simple and effective tool for the early identification of patients at increased risk of adverse outcomes in sepsis.
Retrospective study.
The Braden score can be employed by clinical nurses for the purpose of early identification of poor prognostic risk in patients with sepsis.
This study was conducted according to the Strengthening Research in Observational Studies in Epidemiology (STROBE) guidelines.
Patients were involved in the sample of the study.
为脓毒症患者高危人群的早期临床识别提供一种可行的工具。
脓毒症相关性谵妄（SAD）有可能对患者的短期和长期预后产生重大影响。然而，准确预测和有效管理SAD仍然是一项重大挑战。
本研究对首次入住重症监护病房（ICU）的成年脓毒症患者进行回顾性分析。根据患者入住ICU时的初始布拉德评分将患者分为两组：高危组（≤15分）和低危组（>15分）。使用逻辑回归和受限立方样条评估布拉德评分与谵妄之间的关系，同时采用受限平均生存时间分析布拉德评分与患者90天和180天死亡率之间的关系。
在纳入研究的28312例患者中，高危组患者出现谵妄的风险显著升高（44.8%对29.7%），90天（28.7%对19.4%）和180天（33.2%对24.1%）死亡率更高（所有p<0.001）。在调整混杂变量后，逻辑回归显示高危组谵妄风险高1.54倍（95%CI=1.45-1.64，p<0.001）。倾向得分匹配后，两个时间点的生存差异均具有统计学意义，高危组在90天和180天时的生存率分别降低7.50天（95%CI=-8.24，-6.75；p<0.001）和15.74天（95%CI=-17.40，-14.08；p<0.001）。
布拉德评分是早期识别脓毒症患者不良结局风险增加的简单有效工具。
回顾性研究。
临床护士可使用布拉德评分早期识别脓毒症患者的不良预后风险。
本研究按照流行病学观察性研究强化报告（STROBE）指南进行。
患者参与了研究样本。
