A ‘real-world’ analysis of risk factors for post liver transplant delirium and the effect on length of stay

Abstract

Background The development of delirium has been previously demonstrated to be associated with an increased risk of mortality and length of stay post liver transplant (LTx) with multiple risk factors being identified in previous studies. In this study, we have aimed to identify the most important variables associated with the onset of post-LTx delirium and understand the effect on length of stay (LOS). Methods All liver transplants for chronic liver disease between 1 August 2012 and 1 August 2017 were included (n = 793). Data were collected for analysis retrospectively from electronic patient records. Results Delirium is associated with an overall increased hospital and ICU LOS but not one-year mortality. The risk of developing post-LTx delirium was the greatest among patients: with post-LTx sepsis, who required renal sparing immunosuppression, who received donation after cardiac death (DCD) grafts and who were older. Patients with autoimmune hepatitis, primary biliary cholangitis or primary sclerosing cholangitis seemed to be at lower risk of post-LTx delirium. However, global patient LOS was only prolonged in patients with sepsis and renal failure. Conclusion Many of the risk factors previously described to be associated with the development of post-LTx delirium were not demonstrated to be significant in this study. Sepsis, renal failure, older age and DCD use are associated with delirium post-LTx. It is unclear if this syndrome is an independent risk factor for increased LOS or if it is a symptom of well established syndromes associated with increased LOS. The role for prophylactic strategies to reduce the incidence of post-LTx delirium is therefore unclear.

A Non-Linear Relationship between Preoperative Total Bilirubin Level and Postoperative Delirium Incidence after Liver Transplantation

“…POD is a frequent and serious complication after OLT as it is closely associated with increased morbidity, mortality, and medical care expenses [8,[20][21][22]. It was demonstrated to increase hospital stay by 2-3 days and was associated with a 30-day mortality of 7-10% in recent literature [5].…”

The influence of delirium on mortality and length of ICU stay and analysis of risk factors for delirium after liver transplantation

“…The relationship between delirium and mortality is controversial. Several studies showed that delirium did not affect in-hospital or 1 year mortality with proper treatment ( 4 , 34 , 35 ). Nevertheless, Lescot et al and Wang et al reported that delirium after LT was related to in-hospital and 1 year mortality ( 2 , 6 ).…”

Predisposing and precipitating risk factors for delirium in gastroenterology and hepatology: Subgroup analysis of 718 patients from a hospital-wide prospective cohort study

“…Renal failure and infection were precipitating factors. Other studies have focused on surgical patients, for instance, in patients undergoing hepatectomy ( 35 , 36 ). As in our cohort, delirium was associated with an overall increased hospital and ICU length of stay.…”