Delirium as a predictor of mortality and disability among hospitalized patients in Zambia

Abstract

Objective To study the epidemiology and outcomes of delirium among hospitalized patients in Zambia. Methods We conducted a prospective cohort study at the University Teaching Hospital in Lusaka, Zambia, from October 2017 to April 2018. The primary exposure was delirium duration over the initial 3 days of hospitalization, assessed daily using the Brief Confusion Assessment Method. The primary outcome was 6-month mortality. Secondary outcomes included 6-month disability, evaluated using the World Health Organization Disability Assessment Schedule 2.0. Findings 711 adults were included (median age, 39 years; 461 men; 459 medical, 252 surgical; 323 with HIV). Delirium prevalence was 48.5% (95% CI, 44.8%-52.3%). 6-month mortality was higher for delirious participants (44.6% [39.3%-50.1%]) versus non-delirious participants (20.0% [15.4%-25.2%]; P < .001). After adjusting for covariates, delirium duration independently predicted 6-month mortality and disability with a significant dose-response association between number of days with delirium and odds of worse clinical outcome. Compared to no delirium, presence of 1, 2 or 3 days of delirium resulted in odds ratios for 6-month mortality of 1.43 (95% CI, 0.73–2.80), 2.20 (1.07–4.51), and 3.92 (2.24–6.87), respectively (P < .001). Odds of 6-month disability were 1.20 (0.70–2.05), 1.73 (0.95–3.17), and 2.80 (1.78–4.43), respectively (P < .001). Conclusion Among hospitalized medical and surgical patients in Zambia, delirium prevalence was high and delirium duration independently predicted mortality and disability at 6 months. This work lays the foundation for prevention, detection, and management of delirium in low-income countries. Long-term follow up of outcomes of critical illness in resource-limited settings appears feasible using the WHO Disability Assessment Schedule.

Stroke unit and Neurocritical Care Unit for acute neurological diseases in the USL Toscana Centro: a pilot model of Santo Stefano Hospital in Prato

“…In the inpatient setting, limited access to basic critical care resources and neurologic expertise means that most neurologic emergencies are managed on low-acuity wards by staff who have received limited focused training in care for acute neurological disease (Dart et al, 2017;Norrving et al, 2018;Banerdt et al, 2021). The care of patients with AND can vary considerably between countries and between healthcare settings due to local epidemiology, affordability of care, health system financing, and resource availability (Prust et al, 2022).…”

Performance of risk scores in predicting mortality at 3, 6, and 12 months in patients diagnosed with community-acquired pneumonia

“…They found that 41.1% of patients with altered mental status upon admission died within the first 48 h, and only 10.8% survived beyond 30 days. Utilizing RS that encompass intrinsic patient traits, clinical indicators and lab results could identify those at elevated risk of long-term mortality from lower respiratory tract infections [ 11 , 13 ]. Yet, evidence concerning the utility of clinical variables and RS in CAP patients remains sparse, given the limitations of long-term mortality studies [ 11 – 14 ].…”

Screening for delirium and dementia in older hospitalised adults in Zambia

“…Estimated community dementia prevalence is 2-6.4% and hospital prevalence 3-5% [9][10][11]. One Zambian delirium study reported a hospital prevalence of 48.5% and that delirium duration independently predicted mortality and disability at 6 months in all age groups [12]. Studies in older populations are even more limited.…”