The influence of delirium on mortality and length of ICU stay and analysis of risk factors for delirium after liver transplantation
ObjectiveTo analyze the incidence, timing, risk factors and prognosis of delirium after liver transplantation (LT).MethodsThe clinical data of 321 patients undergoing LT in the Third Xiangya Hospital of Central South University from January 2018 to December 2022 were collected to investigate the inc...
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| Format: | Article |
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Frontiers Media S.A.
2023-10-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2023.1229990/full |
| _version_ | 1797665819181711360 |
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| author | Ying Ma Ying Ma Cuiying Li Cuiying Li Weiting Peng Qiquan Wan Qiquan Wan |
| author_facet | Ying Ma Ying Ma Cuiying Li Cuiying Li Weiting Peng Qiquan Wan Qiquan Wan |
| author_sort | Ying Ma |
| collection | DOAJ |
| description | ObjectiveTo analyze the incidence, timing, risk factors and prognosis of delirium after liver transplantation (LT).MethodsThe clinical data of 321 patients undergoing LT in the Third Xiangya Hospital of Central South University from January 2018 to December 2022 were collected to investigate the incidence, onset, and risk factors for post-LT delirium and the impact of delirium on LT recipients’ prognosis by statistical analysis.ResultsThe incidence of post-LT delirium was 19.3% (62/321), and the median interval between LT and onset of delirium was 20.1 h. Univariate analysis showed that pre-LT variables (Model for End Stage Liver Disease (MELD) score, hospital stay, hepatic encephalopathy, infection, white blood cell (WBC) count, lymphocyte count, abnormal potassium, lactulose use), intraoperative variables (red blood cell transfusion, remimazolam use, dexmedetomidine use) and post-LT variables (hypernatraemia, acute rejection, reoperation, basiliximab use, tacrolimus concentration) were associated with post-LT delirium. Multivariate logistic regression analysis revealed that MELD score at LT ≥22 [OR = 3.400, 95% CI:1.468–7.876, p = 0.004], pre-LT hepatic encephalopathy [OR = 3.224, 95% CI:1.664–6.244, p = 0.001], infection within 2 months prior to LT [OR = 2.238, 95% CI:1.151–4.351, p = 0.018], acute rejection [OR = 2.974, 95% CI:1.322–6.690, p = 0.008], and reoperation [OR = 11.919, 95% CI:2.938–48.350, p = 0.001] were independent risk factors for post-LT delirium. Post-LT delirium was reduced in LT recipients exposing to intraoperative remimazolam [OR = 0.287, 95% CI: 0.113–0.733, p = 0.009] or ≥ 25 μg of intraoperative dexmedetomidine [OR = 0.441, 95% CI 0.225–0.867, p = 0.018]. As for clinical outcomes, patients with delirium had a higher percentage of staying at the (ICU) ≥7 d after LT than those without delirium [OR = 2.559, 95% CI 1.418–4.617, p = 0.002].ConclusionThe incidence of delirium was high and the onset of delirium was early after LT. Risk factors for post-LT delirium included high MELD score at LT, pre-LT hepatic encephalopathy and infections, acute rejection and reoperation. Intraoperative use of remimazolam or dexmedetomidine reduced post-LT delirium. Delirium had a negative impact on the length of ICU stay. |
| first_indexed | 2024-03-11T19:49:33Z |
| format | Article |
| id | doaj.art-8f226157318145889a4b45dbb2e61467 |
| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-03-11T19:49:33Z |
| publishDate | 2023-10-01 |
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| series | Frontiers in Neurology |
| spelling | doaj.art-8f226157318145889a4b45dbb2e614672023-10-05T12:25:08ZengFrontiers Media S.A.Frontiers in Neurology1664-22952023-10-011410.3389/fneur.2023.12299901229990The influence of delirium on mortality and length of ICU stay and analysis of risk factors for delirium after liver transplantationYing Ma0Ying Ma1Cuiying Li2Cuiying Li3Weiting Peng4Qiquan Wan5Qiquan Wan6Department of Transplant Surgery, The Third Xiangya Hospital of Central South University, Changsha, ChinaEngineering and Technology Research Center for Transplantation Medicine of National Health Commission, The Third Xiangya Hospital of Central South University, Changsha, ChinaDepartment of Transplant Surgery, The Third Xiangya Hospital of Central South University, Changsha, ChinaEngineering and Technology Research Center for Transplantation Medicine of National Health Commission, The Third Xiangya Hospital of Central South University, Changsha, ChinaClass 2, Grade 2019, 8-Year Clinical Medicine Program, Xiangya School of Medicine, Central South University, Changsha, ChinaDepartment of Transplant Surgery, The Third Xiangya Hospital of Central South University, Changsha, ChinaEngineering and Technology Research Center for Transplantation Medicine of National Health Commission, The Third Xiangya Hospital of Central South University, Changsha, ChinaObjectiveTo analyze the incidence, timing, risk factors and prognosis of delirium after liver transplantation (LT).MethodsThe clinical data of 321 patients undergoing LT in the Third Xiangya Hospital of Central South University from January 2018 to December 2022 were collected to investigate the incidence, onset, and risk factors for post-LT delirium and the impact of delirium on LT recipients’ prognosis by statistical analysis.ResultsThe incidence of post-LT delirium was 19.3% (62/321), and the median interval between LT and onset of delirium was 20.1 h. Univariate analysis showed that pre-LT variables (Model for End Stage Liver Disease (MELD) score, hospital stay, hepatic encephalopathy, infection, white blood cell (WBC) count, lymphocyte count, abnormal potassium, lactulose use), intraoperative variables (red blood cell transfusion, remimazolam use, dexmedetomidine use) and post-LT variables (hypernatraemia, acute rejection, reoperation, basiliximab use, tacrolimus concentration) were associated with post-LT delirium. Multivariate logistic regression analysis revealed that MELD score at LT ≥22 [OR = 3.400, 95% CI:1.468–7.876, p = 0.004], pre-LT hepatic encephalopathy [OR = 3.224, 95% CI:1.664–6.244, p = 0.001], infection within 2 months prior to LT [OR = 2.238, 95% CI:1.151–4.351, p = 0.018], acute rejection [OR = 2.974, 95% CI:1.322–6.690, p = 0.008], and reoperation [OR = 11.919, 95% CI:2.938–48.350, p = 0.001] were independent risk factors for post-LT delirium. Post-LT delirium was reduced in LT recipients exposing to intraoperative remimazolam [OR = 0.287, 95% CI: 0.113–0.733, p = 0.009] or ≥ 25 μg of intraoperative dexmedetomidine [OR = 0.441, 95% CI 0.225–0.867, p = 0.018]. As for clinical outcomes, patients with delirium had a higher percentage of staying at the (ICU) ≥7 d after LT than those without delirium [OR = 2.559, 95% CI 1.418–4.617, p = 0.002].ConclusionThe incidence of delirium was high and the onset of delirium was early after LT. Risk factors for post-LT delirium included high MELD score at LT, pre-LT hepatic encephalopathy and infections, acute rejection and reoperation. Intraoperative use of remimazolam or dexmedetomidine reduced post-LT delirium. Delirium had a negative impact on the length of ICU stay.https://www.frontiersin.org/articles/10.3389/fneur.2023.1229990/fullliver transplantationdeliriumrisk factorsprognosisICU stay |
| spellingShingle | Ying Ma Ying Ma Cuiying Li Cuiying Li Weiting Peng Qiquan Wan Qiquan Wan The influence of delirium on mortality and length of ICU stay and analysis of risk factors for delirium after liver transplantation Frontiers in Neurology liver transplantation delirium risk factors prognosis ICU stay |
| title | The influence of delirium on mortality and length of ICU stay and analysis of risk factors for delirium after liver transplantation |
| title_full | The influence of delirium on mortality and length of ICU stay and analysis of risk factors for delirium after liver transplantation |
| title_fullStr | The influence of delirium on mortality and length of ICU stay and analysis of risk factors for delirium after liver transplantation |
| title_full_unstemmed | The influence of delirium on mortality and length of ICU stay and analysis of risk factors for delirium after liver transplantation |
| title_short | The influence of delirium on mortality and length of ICU stay and analysis of risk factors for delirium after liver transplantation |
| title_sort | influence of delirium on mortality and length of icu stay and analysis of risk factors for delirium after liver transplantation |
| topic | liver transplantation delirium risk factors prognosis ICU stay |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2023.1229990/full |
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