Inouye S K, Rushing J T, Foreman M D, Palmer R M, Pompei P
Department of Internal Medicine, Yale University School of Medicine, New Haven, Conn 06504, USA.
J Gen Intern Med. 1998 Apr;13(4):234-42. doi: 10.1046/j.1525-1497.1998.00073.x.
To determine the independent contribution of admission delirium to hospital outcomes including mortality, institutionalization, and functional decline.
Three prospective cohort studies.
Three university-affiliated teaching hospitals.
Consecutive samples of 727 patients, aged 65 years and older.
Delirium was present at admission in 88 (12%) of 727 patients. The main outcome measures at hospital discharge and 3-month follow-up were death, new nursing home placement, death or new nursing home placement, and functional decline. At hospital discharge, new nursing home placement occurred in 60 (9%) of 692 patients, and the adjusted odds ratio (OR) for delirium, controlling for baseline covariates of age, gender, dementia, APACHE II score, and functional measures, was 3.0, (95% confidence interval [CI] 1.4, 6.2). Death or new nursing home placement occurred in 95 (13%) of 727 patients (adjusted OR for delirium 2.1, 95% CI 1.1, 4.0). The findings were replicated across all sites. The associations between delirium and death alone (in 35 [5%] of 727 patients) and between delirium and length of stay were not statistically significant. At 3-month follow-up, new nursing home placement occurred in 77 (13%) of 600 patients (adjusted OR for delirium 3.0; 95% CI 1.5, 6.0). Death or new nursing home placement occurred in 165 (25%) of 663 patients (adjusted OR for delirium 2.6; 95% CI 1.4, 4.5). The findings were replicated across all sites. For death alone (in 98 [14%] of 680 patients), the adjusted OR for delirium was 1.6 (95% CI 0.8, 3.2). Delirium was a significant predictor of functional decline at both hospital discharge (adjusted OR 3.0; 95% CI 1.6, 5.8) and follow-up (adjusted OR 2.7; 95% CI 1.4, 5.2).
Delirium is an important independent prognostic determinant of hospital outcomes including new nursing home placement, death or new nursing home placement, and functional decline-even after controlling for age, gender, dementia, illness severity, and functional status. Thus, delirium should be considered as a prognostic variable in case-mix adjustment systems and in studies examining hospital outcomes in older persons.
确定入院时谵妄对包括死亡率、入住养老院及功能衰退等医院结局的独立影响。
三项前瞻性队列研究。
三家大学附属医院。
727例年龄在65岁及以上的连续样本患者。
727例患者中有88例（12%）入院时存在谵妄。出院时及3个月随访时的主要结局指标为死亡、新入住养老院、死亡或新入住养老院以及功能衰退。出院时，692例患者中有60例（9%）新入住养老院，在控制了年龄、性别、痴呆、急性生理与慢性健康状况评分系统（APACHE II）得分及功能指标等基线协变量后，谵妄的校正比值比（OR）为3.0（95%置信区间[CI] 1.4，6.2）。727例患者中有95例（13%）死亡或新入住养老院（谵妄的校正OR为2.1，95% CI 1.1，4.0）。所有研究地点均重复了该结果。谵妄与单独死亡（727例患者中的35例[5%]）以及谵妄与住院时间之间的关联无统计学意义。在3个月随访时，600例患者中有77例（13%）新入住养老院（谵妄的校正OR为3.0；95% CI 1.5，6.0）。663例患者中有165例（25%）死亡或新入住养老院（谵妄的校正OR为2.6；95% CI 1.4，4.5）。所有研究地点均重复了该结果。对于单独死亡（680例患者中的98例[14%]），谵妄的校正OR为1.6（95% CI 0.8，3.2）。谵妄是出院时（校正OR 3.0；95% CI 1.6，5.8）及随访时（校正OR 2.7；95% CI 1.4，5.2）功能衰退的重要预测因素。
即使在控制了年龄、性别、痴呆、疾病严重程度及功能状态后，谵妄仍是包括新入住养老院、死亡或新入住养老院以及功能衰退等医院结局的重要独立预后决定因素。因此，在病例组合调整系统及研究老年人医院结局的研究中，应将谵妄视为一个预后变量。
