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 and Ruth Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
Galter Health Sciences Library and Learning Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
Eur Respir Rev. 2025 Sep 17;34(177). doi: 10.1183/16000617.0111-2025. Print 2025 Jul.
Delirium can occur in patients with pneumonia, but its prevalence is inconsistent across studies. Unreliable estimates and uncertainty regarding the significance of patient-specific 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 6 August 2024. We included studies in adults hospitalised 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. The review protocol was registered with PROSPERO: CRD42023385571.
Delirium prevalence across 126 studies was 22% (95% CI 18-26%) and higher in studies at low risk of bias (40%, 95% CI 24%-58%; n=11). Standardised assessments yielded higher rates than symptom- or International Classification of Diseases code-based assessments (p<0.05). Surprisingly, delirium rates did not differ by microbiological aetiology (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 (odds ratio 4.3, 95% CI 3.24-5.76; p<0.001), without change over five decades (p=0.32).
Delirium is highly prevalent and enduring in pneumonia, with nearly double the estimated prevalence when standardised diagnostic methods for both pneumonia and delirium are used. Our results emphasise 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。患者特异性微生物危险因素的估计不可靠以及其意义存在不确定性，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），检索时间从数据库创建至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、微生物学因素、临床因素和死亡率进行了预先设定的分析，并在低偏倚风险的研究中进行了敏感性分析。该综述方案已在PROSPERO注册：CRD42023385571。
126项研究中谵妄的患病率为22%（95%可信区间18%-26%），在低偏倚风险的研究中患病率更高（40%，95%可信区间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编码的评估（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）中并无差异，包括新冠病毒感染，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（优势比4.3，95%可信区间3.24-5.76；p<0.001），在五十年间无变化（p = 0.32）。
谵妄在肺炎中高度普遍且持续存在，当同时使用肺炎和谵妄的标准化诊断方法时，估计患病率几乎翻倍。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。谵妄与死亡率的固有关联，即使考虑协变量，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。
