Kaewpongsa Panumas, Jayanama Kulapong, Ruangritchankul Sirasa
Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Faculty of Medicine Ramathibodi Hospital, Chakri Naruebodindra Medical Institute, Mahidol University, Samut Prakan, Thailand.
BMC Psychiatry. 2025 Apr 3;25(1):330. doi: 10.1186/s12888-025-06731-5.
Hyperactive delirium is a common complication in older medical inpatients in non-intensive care units. This condition increases the risk of diminished physical function, morbidity, and mortality. Moreover, antipsychotics and sedatives were widely used in these patients, contributing to many drug interactions and adverse drug reactions. This study aimed to evaluate the risk factors for hyperactive delirium and assess adverse outcomes among these susceptible patients.
We conducted a prospective observational study to examine hyperactive delirium as an exposure and its association with adverse outcomes without intervention. A total of 238 medical patients aged ≥ 60 admitted to non-intensive care units at Ramathibodi Hospital between September 1, 2022, and December 31, 2023, were enrolled. The clinical characteristics, physical examination, and biochemical profiles at baseline were assessed. Adverse clinical outcomes at 90 days after discharge were evaluated by reviewing electronic medical records (EMRs). The Confusion Assessment Method and Richmond Agitation-Sedation Scale (RASS) score of + 1 to + 4 were used to diagnose hyperactive delirium. The Cox proportional hazard model was performed to identify risk factors and adverse clinical outcomes associated with hyperactive delirium, with results reported as hazard ratios (HRs) and 95% confidence intervals (CIs).
Overall, hyperactive delirium was diagnosed in 115 (48.3%) patients and had an incidence rate of 101.1 cases per 1000 person-days. The risk factors for hyperactive delirium were urinary incontinence (HR 1.69, 95% CI 1.11-2.57), clinical frailty scale (CFS) ≥ 5 (HR 2.79, 95% CI 1.69-4.62), and Montreal Cognitive Assessment (MoCA) score < 25 (HR 4.63, 95% CI 1.09-19.75). Within 90 days after discharge, 14 (12.2%) patients with delirium had died. Medical inpatients who experienced hyperactive delirium had an 8.23-fold increased risk of 90-day mortality following hospital discharge compared to those without delirium (HR 8.23, 95% CI 1.38-48.98).
The risk factors for hyperactive delirium were urinary incontinence, frailty (CFS score ≥ 5), and cognitive impairment (MoCA score < 25). Among older medical inpatients, hyperactive delirium was an independent predictor of 90-day mortality after discharge.
躁动谵妄是老年内科非重症监护病房患者常见的并发症。这种情况会增加身体功能减退、发病和死亡的风险。此外，抗精神病药物和镇静剂在这些患者中广泛使用，导致许多药物相互作用和药物不良反应。本研究旨在评估躁动谵妄的危险因素，并评估这些易感患者的不良结局。
我们进行了一项前瞻性观察性研究，将躁动谵妄作为一种暴露因素，并研究其与未干预情况下不良结局的关联。2022年9月1日至2023年12月31日期间，共有238名年龄≥60岁的内科患者入住拉玛蒂博迪医院非重症监护病房并被纳入研究。评估了基线时的临床特征、体格检查和生化指标。通过查阅电子病历（EMR）评估出院后90天的不良临床结局。采用谵妄评估方法和里士满躁动镇静量表（RASS）评分+1至+4来诊断躁动谵妄。采用Cox比例风险模型确定与躁动谵妄相关的危险因素和不良临床结局，结果以风险比（HRs）和95%置信区间（CIs）表示。
总体而言，115名（48.3%）患者被诊断为躁动谵妄，发病率为每1000人日101.1例。躁动谵妄的危险因素包括尿失禁（HR 1.69，95% CI 1.11 - 2.57）、临床衰弱量表（CFS）≥5（HR 2.79，95% CI 1.69 - 4.62）和蒙特利尔认知评估（MoCA）评分<25（HR 4.63，95% CI 1.09 - 19.75）。出院后90天内，14名（12.2%）谵妄患者死亡。与未发生谵妄的内科患者相比，发生躁动谵妄的内科患者出院后90天死亡风险增加8.23倍（HR 8.23，95% CI 1.38 - 48.98）。
躁动谵妄的危险因素包括尿失禁、衰弱（CFS评分≥5）和认知障碍（MoCA评分<25）。在老年内科患者中，躁动谵妄是出院后90天死亡率的独立预测因素。
