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Long-term outcome of delirium during intensive care unit stay in survivors of critical illness: a prospective cohort study.
Crit Care. 2014 Jun 18; 18(3):R125.CC

Abstract

INTRODUCTION

Delirium is associated with impaired outcome, but it is unclear whether this relationship is limited to in-hospital outcomes and whether this relationship is independent of the severity of underlying conditions. The aim of this study was to investigate the association between delirium in the intensive care unit (ICU) and long-term mortality, self-reported health-related quality of life (HRQoL), and self-reported problems with cognitive functioning in survivors of critical illness, taking severity of illness at baseline and throughout ICU stay into account.

METHODS

A prospective cohort study was conducted. We included patients who survived an ICU stay of at least a day; exclusions were neurocritical care patients and patients who sustained deep sedation during the entire ICU stay. Delirium was assessed twice daily with the Confusion Assessment Method for the ICU (CAM-ICU) and additionally, patients who received haloperidol were considered delirious. Twelve months after ICU admission, data on mortality were obtained and HRQoL and cognitive functioning were measured with the European Quality of Life - Six dimensions self-classifier (EQ-6D). Regression analyses were used to assess the associations between delirium and the outcome measures adjusted for gender, type of admission, the Acute Physiology And Chronic Health Evaluation IV (APACHE IV) score, and the cumulative Sequential Organ Failure Assessment (SOFA) score throughout ICU stay.

RESULTS

Of 1101 survivors of critical illness, 412 persons (37%) had been delirious during ICU stay, and 198 (18%) died within twelve months. When correcting for confounders, no significant association between delirium and long-term mortality was found (hazard ratio: 1.26; 95% confidence interval (CI) 0.93 to 1.71). In multivariable analysis, delirium was not associated with HRQoL either (regression coefficient: -0.04; 95% CI -0.10 to 0.01). Yet, delirium remained associated with mild and severe problems with cognitive functioning in multivariable analysis (odds ratios: 2.41; 95% CI 1.57 to 3.69 and 3.10; 95% CI 1.10 to 8.74, respectively).

CONCLUSIONS

In this group of survivors of critical illness, delirium during ICU stay was not associated with long-term mortality or HRQoL after adjusting for confounding, including severity of illness throughout ICU stay. In contrast, delirium appears to be an independent risk factor for long-term self-reported problems with cognitive functioning.

Authors

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Pub Type(s)

Journal Article

Language

eng

PubMed ID

24942154

Citation

Wolters, Annemiek E., et al. "Long-term Outcome of Delirium During Intensive Care Unit Stay in Survivors of Critical Illness: a Prospective Cohort Study." Critical Care (London, England), vol. 18, no. 3, 2014, pp. R125.
Wolters AE, van Dijk D, Pasma W, et al. Long-term outcome of delirium during intensive care unit stay in survivors of critical illness: a prospective cohort study. Crit Care. 2014;18(3):R125.
Wolters, A. E., van Dijk, D., Pasma, W., Cremer, O. L., Looije, M. F., de Lange, D. W., Veldhuijzen, D. S., & Slooter, A. J. (2014). Long-term outcome of delirium during intensive care unit stay in survivors of critical illness: a prospective cohort study. Critical Care (London, England), 18(3), R125. https://doi.org/10.1186/cc13929
Wolters AE, et al. Long-term Outcome of Delirium During Intensive Care Unit Stay in Survivors of Critical Illness: a Prospective Cohort Study. Crit Care. 2014 Jun 18;18(3):R125. PubMed PMID: 24942154.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Long-term outcome of delirium during intensive care unit stay in survivors of critical illness: a prospective cohort study. AU - Wolters,Annemiek E, AU - van Dijk,Diederik, AU - Pasma,Wietze, AU - Cremer,Olaf L, AU - Looije,Marjolein F, AU - de Lange,Dylan W, AU - Veldhuijzen,Dieuwke S, AU - Slooter,Arjen J C, Y1 - 2014/06/18/ PY - 2013/12/24/received PY - 2014/06/04/accepted PY - 2014/6/20/entrez PY - 2014/6/20/pubmed PY - 2015/5/15/medline SP - R125 EP - R125 JF - Critical care (London, England) JO - Crit Care VL - 18 IS - 3 N2 - INTRODUCTION: Delirium is associated with impaired outcome, but it is unclear whether this relationship is limited to in-hospital outcomes and whether this relationship is independent of the severity of underlying conditions. The aim of this study was to investigate the association between delirium in the intensive care unit (ICU) and long-term mortality, self-reported health-related quality of life (HRQoL), and self-reported problems with cognitive functioning in survivors of critical illness, taking severity of illness at baseline and throughout ICU stay into account. METHODS: A prospective cohort study was conducted. We included patients who survived an ICU stay of at least a day; exclusions were neurocritical care patients and patients who sustained deep sedation during the entire ICU stay. Delirium was assessed twice daily with the Confusion Assessment Method for the ICU (CAM-ICU) and additionally, patients who received haloperidol were considered delirious. Twelve months after ICU admission, data on mortality were obtained and HRQoL and cognitive functioning were measured with the European Quality of Life - Six dimensions self-classifier (EQ-6D). Regression analyses were used to assess the associations between delirium and the outcome measures adjusted for gender, type of admission, the Acute Physiology And Chronic Health Evaluation IV (APACHE IV) score, and the cumulative Sequential Organ Failure Assessment (SOFA) score throughout ICU stay. RESULTS: Of 1101 survivors of critical illness, 412 persons (37%) had been delirious during ICU stay, and 198 (18%) died within twelve months. When correcting for confounders, no significant association between delirium and long-term mortality was found (hazard ratio: 1.26; 95% confidence interval (CI) 0.93 to 1.71). In multivariable analysis, delirium was not associated with HRQoL either (regression coefficient: -0.04; 95% CI -0.10 to 0.01). Yet, delirium remained associated with mild and severe problems with cognitive functioning in multivariable analysis (odds ratios: 2.41; 95% CI 1.57 to 3.69 and 3.10; 95% CI 1.10 to 8.74, respectively). CONCLUSIONS: In this group of survivors of critical illness, delirium during ICU stay was not associated with long-term mortality or HRQoL after adjusting for confounding, including severity of illness throughout ICU stay. In contrast, delirium appears to be an independent risk factor for long-term self-reported problems with cognitive functioning. SN - 1466-609X UR - https://www.unboundmedicine.com/medline/citation/24942154/Long_term_outcome_of_delirium_during_intensive_care_unit_stay_in_survivors_of_critical_illness:_a_prospective_cohort_study_ L2 - https://ccforum.biomedcentral.com/articles/10.1186/cc13929 DB - PRIME DP - Unbound Medicine ER -