Prognostic significance of delirium subtypes in critically ill medical and surgical patients: a secondary analysis of a prospective multicenter study
Abstract Background The prognostic implication of delirium subtypes in critically ill medical and surgical patients is scarcely investigated. The objective was to determine how delirium subtypes are associated with hospital mortality and other clinical outcomes. Methods We performed a secondary anal...
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| Format: | Article |
| Language: | English |
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BMC
2022-12-01
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| Series: | Journal of Intensive Care |
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| Online Access: | https://doi.org/10.1186/s40560-022-00644-1 |
| _version_ | 1797977580540788736 |
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| author | Lisa Smit Eveline J. A. Wiegers Zoran Trogrlic Wim J. R. Rietdijk Diederik Gommers Erwin Ista Mathieu van der Jagt |
| author_facet | Lisa Smit Eveline J. A. Wiegers Zoran Trogrlic Wim J. R. Rietdijk Diederik Gommers Erwin Ista Mathieu van der Jagt |
| author_sort | Lisa Smit |
| collection | DOAJ |
| description | Abstract Background The prognostic implication of delirium subtypes in critically ill medical and surgical patients is scarcely investigated. The objective was to determine how delirium subtypes are associated with hospital mortality and other clinical outcomes. Methods We performed a secondary analysis on data from a prospective multicenter study aimed at implementation of delirium-oriented measures, conducted between 2012 and 2015 in The Netherlands. We included adults (≥ 18 years) admitted to the medical or surgical intensive care unit (ICU). Exclusion criteria were neurological admission diagnosis, persistent coma or ICU readmissions. Delirium was assessed using the Confusion Assessment Method-ICU or Intensive Care Delirium Screening Checklist, and delirium subtypes (hypoactive, hyperactive, or mixed) were classified using the Richmond Agitation–Sedation Scale. The main outcome was hospital mortality. Secondary outcomes were ICU mortality, ICU length of stay, coma, mechanical ventilation, and use of antipsychotics, sedatives, benzodiazepines and opioids. Results Delirium occurred in 381 (24.4%) of 1564 patients (52.5% hypoactive, 39.1% mixed, 7.3% hyperactive). After case-mix adjustment, patients with mixed delirium had higher hospital mortality than non-delirious patients (OR 3.09, 95%CI 1.79–5.33, p = 0.001), whereas hypoactive patients did not (OR 1.34, 95%CI 0.71–2.55, p = 0.37). Similar results were found for ICU mortality. Compared to non-delirious patients, both subtypes had longer ICU stay, more coma, increased mechanical ventilation frequency and duration, and received more antipsychotics, sedatives, benzodiazepines and opioids. Except for coma and benzodiazepine use, the most unfavourable outcomes were observed in patients with mixed delirium. Conclusions Patients with mixed delirium had the most unfavourable outcomes, including higher mortality, compared with no delirium. These differences argue for distinguishing delirium subtypes in clinical practice and future research. Trial registration ClinicalTrials.gov NCT01952899. |
| first_indexed | 2024-04-11T05:09:15Z |
| format | Article |
| id | doaj.art-02ce1033b3554efe874c86f35c6dc9ec |
| institution | Directory Open Access Journal |
| issn | 2052-0492 |
| language | English |
| last_indexed | 2024-04-11T05:09:15Z |
| publishDate | 2022-12-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Intensive Care |
| spelling | doaj.art-02ce1033b3554efe874c86f35c6dc9ec2022-12-25T12:06:30ZengBMCJournal of Intensive Care2052-04922022-12-0110111010.1186/s40560-022-00644-1Prognostic significance of delirium subtypes in critically ill medical and surgical patients: a secondary analysis of a prospective multicenter studyLisa Smit0Eveline J. A. Wiegers1Zoran Trogrlic2Wim J. R. Rietdijk3Diederik Gommers4Erwin Ista5Mathieu van der Jagt6Department of Intensive Care Adults, Erasmus MC, University Medical CenterDepartment of Public Health, Erasmus MC, University Medical CenterDepartment of Intensive Care Adults, Erasmus MC, University Medical CenterDepartment of Hospital Pharmacy, Erasmus MC, University Medical CenterDepartment of Intensive Care Adults, Erasmus MC, University Medical CenterIntensive Care Unit, Department of Pediatric Surgery, Erasmus MC-Sophia Children’s Hospital, University Medical CenterDepartment of Intensive Care Adults, Erasmus MC, University Medical CenterAbstract Background The prognostic implication of delirium subtypes in critically ill medical and surgical patients is scarcely investigated. The objective was to determine how delirium subtypes are associated with hospital mortality and other clinical outcomes. Methods We performed a secondary analysis on data from a prospective multicenter study aimed at implementation of delirium-oriented measures, conducted between 2012 and 2015 in The Netherlands. We included adults (≥ 18 years) admitted to the medical or surgical intensive care unit (ICU). Exclusion criteria were neurological admission diagnosis, persistent coma or ICU readmissions. Delirium was assessed using the Confusion Assessment Method-ICU or Intensive Care Delirium Screening Checklist, and delirium subtypes (hypoactive, hyperactive, or mixed) were classified using the Richmond Agitation–Sedation Scale. The main outcome was hospital mortality. Secondary outcomes were ICU mortality, ICU length of stay, coma, mechanical ventilation, and use of antipsychotics, sedatives, benzodiazepines and opioids. Results Delirium occurred in 381 (24.4%) of 1564 patients (52.5% hypoactive, 39.1% mixed, 7.3% hyperactive). After case-mix adjustment, patients with mixed delirium had higher hospital mortality than non-delirious patients (OR 3.09, 95%CI 1.79–5.33, p = 0.001), whereas hypoactive patients did not (OR 1.34, 95%CI 0.71–2.55, p = 0.37). Similar results were found for ICU mortality. Compared to non-delirious patients, both subtypes had longer ICU stay, more coma, increased mechanical ventilation frequency and duration, and received more antipsychotics, sedatives, benzodiazepines and opioids. Except for coma and benzodiazepine use, the most unfavourable outcomes were observed in patients with mixed delirium. Conclusions Patients with mixed delirium had the most unfavourable outcomes, including higher mortality, compared with no delirium. These differences argue for distinguishing delirium subtypes in clinical practice and future research. Trial registration ClinicalTrials.gov NCT01952899.https://doi.org/10.1186/s40560-022-00644-1DeliriumCritical careIntensive care unitMortalitySubtypeCritical care outcomes |
| spellingShingle | Lisa Smit Eveline J. A. Wiegers Zoran Trogrlic Wim J. R. Rietdijk Diederik Gommers Erwin Ista Mathieu van der Jagt Prognostic significance of delirium subtypes in critically ill medical and surgical patients: a secondary analysis of a prospective multicenter study Journal of Intensive Care Delirium Critical care Intensive care unit Mortality Subtype Critical care outcomes |
| title | Prognostic significance of delirium subtypes in critically ill medical and surgical patients: a secondary analysis of a prospective multicenter study |
| title_full | Prognostic significance of delirium subtypes in critically ill medical and surgical patients: a secondary analysis of a prospective multicenter study |
| title_fullStr | Prognostic significance of delirium subtypes in critically ill medical and surgical patients: a secondary analysis of a prospective multicenter study |
| title_full_unstemmed | Prognostic significance of delirium subtypes in critically ill medical and surgical patients: a secondary analysis of a prospective multicenter study |
| title_short | Prognostic significance of delirium subtypes in critically ill medical and surgical patients: a secondary analysis of a prospective multicenter study |
| title_sort | prognostic significance of delirium subtypes in critically ill medical and surgical patients a secondary analysis of a prospective multicenter study |
| topic | Delirium Critical care Intensive care unit Mortality Subtype Critical care outcomes |
| url | https://doi.org/10.1186/s40560-022-00644-1 |
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