Juarez-Martinez Erika L, Araia Aida, Prasad Dillan, Dhar Shreya, Nandoliya Khizar, Sherrington Ian G, Zhao Catherine, Wescott Annie, Pickens Chiagozie I, Wunderink Richard G, Kimchi Eyal Y
Ken & Ruth Davee Department of Neurology, Feinberg School of Medicine, Northwestern University. Chicago, Illinois, 60611.
Galter Health Sciences Library & Learning Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611.
medRxiv. 2025 Jun 1:2025.06.01.25328725. doi: 10.1101/2025.06.01.25328725.
Delirium can occur in patients with pneumonia, but its prevalence is inconsistent across studies. Unreliable estimates and uncertainty regarding the significance of patient-specific vs. microbiological risk factors hinder delirium management and prognosis. Here, we provide robust estimates of delirium prevalence in patients with pneumonia, associated risk factors, and association with mortality.
We searched five databases (MEDLINE, Cochrane Library, Embase, PsycINFO, and Scopus), from inception to August 6, 2024. We included studies in adults hospitalized with pneumonia reporting delirium, encephalopathy, or altered mental status. Two investigators extracted data and assessed risk of bias. Summary rates were calculated using random-effects models. We performed prespecified analyses for diagnostic methods, microbiologic factors, clinical factors, and mortality, with sensitivity analysis among studies at low risk of bias. Registration: PROSPERO-CRD42023385571.
Delirium prevalence across 126 studies was 22% (95% CI [18%-26%]), and higher in studies at low risk of bias (40% [24%-58%], n=11). Standardized assessments yielded higher rates than symptom- or ICD code-based assessments (p<0.05). Surprisingly, delirium rates did not differ by microbiological etiology (p0.63), including COVID-19, nor by pneumonia origin (p=0.14). Predisposing factors included older age and neurologic and systemic comorbidities. Delirium was associated with increased mortality (OR 4.3 [3.24-5.76], p<0.001), without change over five decades (p = 0.32).
Delirium is highly prevalent and enduring in pneumonia. Our results emphasize patient- and care-related factors over microbiological causes, including COVID-19. Delirium's entrenched association with mortality, even considering covariates, reinforces the need to manage delirium as a convergent syndrome in pneumonia.
肺炎患者可能会出现谵妄，但不同研究中其患病率并不一致。关于患者特异性与微生物危险因素的重要性，存在不可靠的估计和不确定性，这阻碍了谵妄的管理和预后评估。在此，我们提供了肺炎患者谵妄患病率、相关危险因素及其与死亡率关联的可靠估计。
我们检索了五个数据库（MEDLINE、Cochrane图书馆、Embase、PsycINFO和Scopus），检索时间从数据库建立至2024年8月6日。我们纳入了报告了谵妄、脑病或精神状态改变的肺炎住院成人患者的研究。两名研究人员提取数据并评估偏倚风险。使用随机效应模型计算汇总率。我们对诊断方法、微生物因素、临床因素和死亡率进行了预设分析，并在低偏倚风险的研究中进行了敏感性分析。注册信息：PROSPERO-CRD42023385571。
126项研究中的谵妄患病率为22%（95%置信区间[18%-26%]），在低偏倚风险的研究中更高（40%[24%-58%]，n = 11）。标准化评估得出的患病率高于基于症状或国际疾病分类代码的评估（p<0.05）。令人惊讶的是，谵妄发生率在不同微生物病因（p = 0.63），包括新冠病毒感染中并无差异，在不同肺炎病因中也无差异（p = 0.14）。易感因素包括老年以及神经和全身合并症。谵妄与死亡率增加相关（比值比4.3[3.24-5.76]，p<0.001），在五十年间无变化（p = 0.32）。
谵妄在肺炎中非常普遍且持续存在。我们的结果强调了与患者和护理相关的因素而非微生物病因，包括新冠病毒感染。谵妄与死亡率之间根深蒂固的关联，即使考虑了协变量，也强化了将谵妄作为肺炎中的一种综合综合征进行管理的必要性。
