Postoperative Delirium in the Intensive Care Unit Predicts Worse Outcomes in Liver Transplant Recipients

Lescot, Thomas; Karvellas, Constantine; Chaudhury, Prosanto; Tchervenkov, Jean; Paraskevas, Steven; Barkun, Jeffrey; Metrakos, Peter; Goldberg, Peter; Magder, Sheldon

doi:10.1155/2013/289185

Cited by 61 publications

(72 citation statements)

References 45 publications

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“…Although few studies have examined the impact of delirium on clinical outcomes in transplant recipients, Lescot and colleagues[35] found that delirium following liver transplant was associated with significantly elevated length of hospital duration and mortality, independent of markers of disease severity. However, to our knowledge, no studies have previously demonstrated that delirium is associated with longer hospital duration among lung patients.…”

Section: Discussionmentioning

confidence: 99%

Delirium affects length of hospital stay after lung transplantation

Smith

Rivelli

Waters

et al. 2015

Journal of Critical Care

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Background Delirium is relatively common following lung transplantation, although its prevalence and prognostic significance have not been systematically studied. The purpose of the present study was to examine pre-transplant predictors of delirium and the short-term impact of delirium on clinical outcomes among lung transplant recipients. Methods Participants underwent pre-transplant cognitive testing using the Repeatable Battery for the Assessment of Neuropsychological Status and the Trail Making Test. Following transplant, delirium was assessed using the Confusion Assessment Method until discharge. Results Sixty-three patients were transplanted between March and November, 2013, of which 23 (37%) developed delirium. Among transplanted patients, 48 patients completed pre-transplant cognitive testing. Better pre-transplant cognitive function was associated with lower risk of delirium (OR = 0.69 [95%CI 0.48, 0.99], P = .043); demographic and clinical features including native disease (P =.236), the Charlson comorbidity index (P = .581), and the lung allocation score (P = .871) were unrelated to risk of delirium, although there was a trend for women to experience delirium less frequently (P =.071). The presence (P = .006) and duration (P = .027) of delirium were both associated with longer hospital stays. Conclusion Delirium occurs in more than one third of patients following lung transplantation. Delirium was associated with poorer pretransplant cognitive functioning and longer hospital stays, after accounting for other medical and demographic factors.

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Section: Discussionmentioning

confidence: 99%

Delirium affects length of hospital stay after lung transplantation

Smith

Rivelli

Waters

et al. 2015

Journal of Critical Care

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“…Surprisingly, a recent study by Iglesias et al [51] refutes this finding that independent predictors of recovery of kidney function postliver transplant were the absence of hepatic allograft dysfunction, younger donor age and lower recipient alanine aminotransferase at time of liver transplant, whereas the recipient of RRT, even in excess of 8 weeks, did not predict postliver transplant kidney function. Finally, Lescot et al [55] showed that delirium postliver transplant correlated with preliver transplant illness severity and portended a three-fold increase in 1-year mortality. Postliver transplant, cirrhotic patients are at risk of hyponatremia, calcineurin inhibitor-induced neurotoxicity (ECIIN) and delirium.…”

Section: Challenges In the Posttransplant Care Of Critically Ill Cirrmentioning

confidence: 99%

Advances in management and prognostication in critically ill cirrhotic patients

Karvellas

Bagshaw

2014

Current Opinion in Critical Care

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“…As delirium has been associated with worse survival and outcomes in other critically ill 3 and transplant populations 8 , it could be expected to have a similar effect in lung transplant recipients. The available data on delirium after lung transplantation is limited to a few small single center studies 9–11 .…”

Section: Introductionmentioning

confidence: 99%

Delirium after lung transplantation: Association with recipient characteristics, hospital resource utilization, and mortality

et al. 2017

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Background Delirium is associated with increased morbidity and mortality. The factors associated with post-lung transplant delirium and its impact on outcomes are under characterized. Methods The medical records of 163 consecutive adult lung transplant recipients were reviewed for delirium within 5 days (early-onset) and 30 hospital days (ever-onset) post-transplantation. A multivariable logistic regression model assessed factors associated with delirium. Multivariable negative binomial regression and Cox proportional hazards models assessed the association of delirium with ventilator duration, intensive care unit (ICU) length of stay (LOS), hospital LOS and one-year mortality. Results Thirty six % developed early-onset and 44% - ever-onset delirium. Obesity (OR 6.35, 95% CI 1.61–24.98) and bolused benzodiazepines within the first post-operative day (OR 2.28, 95% CI 1.07–4.89) were associated with early-onset delirium. Early-onset delirium was associated with longer adjusted mechanical ventilation duration (p=0.001), ICU LOS (p<0.001), and hospital LOS (p=0.005). Ever-onset delirium was associated with longer ICU (p<0.001) and hospital LOS (p<0.001). After adjusting for clinical variables, delirium was not significantly associated with one-year mortality (early-onset HR 1.65, 95% CI 0.67–4.03; ever-onset HR 1.70, 95% CI 0.63–4.55). Conclusions Delirium is common after lung transplant surgery and associated with increased hospital resources.

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Postoperative Delirium in the Intensive Care Unit Predicts Worse Outcomes in Liver Transplant Recipients

Abstract: Intraoperative transfusion of packed red blood cells, pretransplantation renal replacement therapy and APACHE II score are predictors for the development of delirium in intensive care unit patients post-OLT and are associated with increased hospital lengths of stay and mortality.

Cited by 61 publications

References 45 publications

Delirium affects length of hospital stay after lung transplantation

Delirium affects length of hospital stay after lung transplantation

Advances in management and prognostication in critically ill cirrhotic patients

Delirium after lung transplantation: Association with recipient characteristics, hospital resource utilization, and mortality

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