Poor outcomes of delirium in the intensive care units are amplified by increasing age: A retrospective cohort study

Abstract

BACKGROUND: Delirium in patients in intensive care units (ICUs) is an acute disturbance and fl uctuation of cognition and consciousness. Though increasing age has been found to be related to ICU delirium, there is limited evidence of the effect of age on delirium outcomes. The aim of this study is to investigate the relationship between age categories and outcomes among ICU delirium patients. METHODS: Data were extracted from the electronic ICU (eICU) Collaborative Research Database with records from 3,931 patients with delirium. Patients were classifi ed into non-aged (<65 years), youngold (65-74 years), middle-old (75-84 years), and very-old (≥85 years) groups. A Cox regression model was built to examine the role of age in death in ICU and in hospital after controlling covariates. RESULTS: The sample included 1,667 (42.4%) non-aged, 891 (22.7%) young-old, 848 (21.6%) middle-old, and 525 (13.3%) very-old patients. The ICU mortality rate was 8.3% and the hospital mortality rate was 15.4%. Compared with the non-aged group, the elderly patients (≥65 yeras) had higher mortality at ICU discharge (χ 2 =13.726, P=0.001) and hospital discharge (χ 2 =56.347, P<0.001). The Cox regression analysis showed that age was an independent risk factor for death at ICU discharge (hazard ratio [HR]=1.502, 1.675, 1.840, 95% confi dence interval [CI] 1.138-1.983, 1.250-2.244, 1.260-2.687; P=0.004, 0.001, 0.002 for the young-, middle-and very-old group, respectively) as well as death at hospital discharge (HR=1.801, 2.036, 2.642, 95% CI 1.454-2.230, 1.638-2.530, 2.047-3.409; all P<0.001). CONCLUSIONS: The risks of death in the ICU and hospital increase with age among delirious patients.

Poor prognostic impact of delirium: especially on mortality and institutionalisation

“…Serpytis et al 15 examined 337 delirium patients with an average age of 76.8 years in a cardiovascular ICU setting in an observational cross-sectional study, and reported that mortality in male patients aged younger than 65 years was higher than in those aged 65 years or older (OR: 1.88). In contrast, Gao et al 16 investigated the relationship between age categories and outcomes among 3931 delirium patients in the ICU, and reported that the risks of death in the ICU and hospital increase with age among patients with delirium. Using the data they reported, patients aged 65 years or older had significantly higher mortality at hospital discharge compared with those aged under 65 years (OR: 2.38).…”

Fokus Neurologische Intensivmedizin 2021/2022

“…Um die Behandlungsrealität des Status epilepticus in Deutschland abzubilden, untersuchten Kowoll et al [ Bis zu 80 % der intensivmedizinischen Behandlungsfälle entwickeln ein Delir mit im Vordergrund stehender Störung der Aufmerksamkeit und Konzentration sowie der Orientierung, des Gedächtnisses und des Bewusstseins mit fluktuierender Ausprägung, sodass es sich um ein häufiges und klinisch relevantes Krankheitsbild handelt [38]. Zu den Risikofaktoren zählt v. a. das Alter der Betroffenen [39]. Mit einem Delir sind u. a. eine längere Beatmungsdauer und v. a. eine signifikant erhöhte Sterblichkeit sowohl während des intensivmedizinischen Aufenthalts als auch in den nachfolgenden 28 Tagen assoziiert [40].…”

Delirium Na Unidade De Terapia Intensiva: Revisão Bibliográfica

“…O delirium consiste em um distúrbio agudo e flutuante 1-5 da cognição 1 e consciência 1,3 que cursa com desatenção [1][2][3][4][5] , confusão mental [1][2][3]5 ou alteração do nível de consciência 2,5 . Entre as manifestações clínicas estão agitação, delírios, alucinações e distúrbios do ciclo sonovigília 6 .…”

“…Nos pacientes hospitalizados, acredita-se que cerca de 30 a 40% dos casos de delirium ocorrem devido a presença de fatores de risco modificáveis 10. Entre os efeitos adversos proporcionados pelo delirium estão estadia hospitalar prolongada [1][2][3][4]6 , altos custos 3,4 , ventilação mecânica prolongada, declínio cognitivo após alta 4 , aumento de morbidade e mortalidade 1,3,4,6,7 intra e extra-hospitalares 4,7 . Estima-se que, anualmente, nos Estados Unidos, são gastos cerca de 10 bilhões de dólares com custos sociais e de saúde com o delirium 7 .…”