Long-term prognostic value of delirium in elderly patients with acute cardiac diseases admitted to two cardiac intensive care units: a prospective study (DELIRIUM CORDIS)

Background: Delirium is a frequent in-hospital complication in elderly patients, and is associated with poor clinical outcome. Its clinical impact, however, has not yet been fully addressed in the setting of the cardiac intensive care unit (CICU). The present study is a prospective, two-centre registry aimed at assessing the incidence, prevalence and significance of delirium in elderly patients with acute cardiac diseases. Methods: Between January 2014 and March 2015, all consecutive patients aged 65 years or older admitted to the CICU of our institutions were enrolled and followed for 6 months. Delirium was defined according to the confusion assessment method. Results: During the study period, 726 patients were screened for delirium. The mean age was 79.1±7.8 years. A total of 111 individuals (15.3%) were diagnosed with delirium; of them, 46 (41.4%) showed prevalent delirium (PD), while 65 (58.6%) developed incident delirium (ID). Patients 85 years or older showed a delirium rate of 52.3%. Hospital stay was longer in delirious versus non-delirious patients. Patients with delirium showed higher in-hospital, 30-day and 6-month mortality compared to non-delirious patients, irrespective of the onset time (overall, ID or PD). Six-month re-hospitalisation was significantly higher in overall delirium and the PD group, as compared to non-delirious patients. Kaplan–Meier analysis showed a significant reduction of 6-month survival in patients with delirium compared to those without, irrespective of delirium onset time (i.e. ID or PD). A positive confusion assessment method was an independent predictor of short and long-term mortality. Conclusions: Delirium is a common complication in elderly CICU patients, and is associated with a longer and more complicated hospital stay and increased short and long-term mortality. Our findings suggest the usefulness of a protocol for the early identification of delirium in the CICU. Clinicaltrials.gov: NCT02004665

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Postoperative delirium after cardiac surgery of elderly patients as an independent risk factor for prolonged length of stay in intensive care unit and in hospital

Aging Clinical and Experimental Research ◽

10.1007/s40520-021-01842-x ◽

2021 ◽

Author(s):

Andrea Kirfel ◽

Jan Menzenbach ◽

Vera Guttenthaler ◽

Johanna Feggeler ◽

Andreas Mayr ◽

...

Keyword(s):

Intensive Care Unit ◽

Cardiac Surgery ◽

Intensive Care ◽

Length Of Stay ◽

Elderly Patients ◽

Postoperative Delirium ◽

Confusion Assessment Method ◽

Assessment Method ◽

Hospital Length Of Stay ◽

Confusion Assessment

Abstract Background Postoperative delirium (POD) is a relevant and underdiagnosed complication after cardiac surgery that is associated with increased intensive care unit (ICU) and hospital length of stay (LOS). The aim of this subgroup study was to compare the frequency of tested POD versus the coded International Statistical Classification of Diseases and Related Health Problems (ICD) diagnosis of POD and to evaluate the influence of POD on LOS in ICU and hospital. Methods 254 elective cardiac surgery patients (mean age, 70.5 ± 6.4 years) at the University Hospital Bonn between September 2018 and October 2019 were evaluated. The endpoint tested POD was considered positive, if one of the tests Confusion Assessment Method for ICU (CAM-ICU) or Confusion Assessment Method (CAM), 4 'A's Test (4AT) or Delirium Observation Scale (DOS) was positive on one day. Results POD occurred in 127 patients (50.0%). LOS in ICU and hospital were significantly different based on presence (ICU 165.0 ± 362.7 h; Hospital 26.5 ± 26.1 days) or absence (ICU 64.5 ± 79.4 h; Hospital 14.6 ± 6.7 days) of POD (p < 0.001). The multiple linear regression showed POD as an independent predictor for a prolonged LOS in ICU (48%; 95%CI 31–67%) and in hospital (64%; 95%CI 27–110%) (p < 0.001). The frequency of POD in the study participants that was coded with the ICD F05.0 and F05.8 by hospital staff was considerably lower than tests revealed by the study personnel. Conclusion Approximately 50% of elderly patients who underwent cardiac surgery developed POD, which is associated with an increased ICU and hospital LOS. Furthermore, POD is highly underdiagnosed in clinical routine.

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Short, and long-term mortality among cardiac intensive care unit patients started on continuous renal replacement therapy

Journal of Critical Care ◽

10.1016/j.jcrc.2019.11.001 ◽

2020 ◽

Vol 55 ◽

pp. 64-72 ◽

Cited By ~ 4

Author(s):

Vasken Keleshian ◽

Kianoush B. Kashani ◽

Panagiotis Kompotiatis ◽

Gregory W. Barsness ◽

Jacob C. Jentzer

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Renal Replacement Therapy ◽

Continuous Renal Replacement Therapy ◽

Replacement Therapy ◽

Cardiac Intensive Care Unit ◽

Short And Long Term ◽

Cardiac Intensive Care ◽

Long Term Mortality

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Comorbidity assessment as predictor of short and long-term mortality in elderly patients with hemodynamically stable acute pulmonary embolism

Journal of Thrombosis and Thrombolysis ◽

10.1007/s11239-017-1540-y ◽

2017 ◽

Vol 44 (3) ◽

pp. 316-323 ◽

Cited By ~ 9

Author(s):

Hernan Polo Friz ◽

Valeria Corno ◽

Annalisa Orenti ◽

Chiara Buzzini ◽

Chiara Crivellari ◽

...

Keyword(s):

Pulmonary Embolism ◽

Elderly Patients ◽

Acute Pulmonary Embolism ◽

Short And Long Term ◽

Long Term Mortality

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Validation study of the European Portuguese version of the Confusion Assessment Method (CAM)

International Psychogeriatrics ◽

10.1017/s1041610214001926 ◽

2014 ◽

Vol 27 (5) ◽

pp. 777-784 ◽

Cited By ~ 11

Author(s):

Sónia Martins ◽

Carla Lourenço ◽

João Pinto-de-Sousa ◽

Filipe Conceição ◽

José Artur Paiva ◽

...

Keyword(s):

Elderly Patients ◽

Predictive Value ◽

Convergent Validity ◽

Confusion Assessment Method ◽

Assessment Method ◽

Intermediate Care ◽

Reference Standard ◽

Confusion Assessment ◽

European Portuguese ◽

Dsm Iv

ABSTRACTBackground:The Confusion Assessment Method (CAM) is the most widely used delirium screening instrument. The aim of this study was to evaluate the reliability and validity of the European Portuguese version of CAM.Methods:The sample included elderly patients (≥65 years), admitted for at least 48 h, into two intermediate care units (ICMU) of Intensive Medicine and Surgical Services in a university hospital. Exclusion criteria were: score ≤11 on the Glasgow Coma Scale (GCS), blindness/deafness, inability to communicate and to speak Portuguese. For concurrent validity, a blinded assessment was conducted by a psychiatrist (DSM-IV-TR, as a reference standard) and by a trained researcher (CAM). This instrument was also compared with other cognitive measures to evaluate convergent validity. Inter-rater reliability was also assessed.Results:In this sample (n = 208), 25% (n = 53) of the patients had delirium, according to DSM-IV-TR. Using this reference standard, the CAM had a moderate sensitivity of 79% and an excellent specificity of 99%. The positive predictive value was 95%, indicating a strong ability to confirm delirium with a positive test result, and the negative predictive value was lower (93%). Good convergent validity was also found, in particular with Mini-Mental State Examination (MMSE) (rs = −0.676; p ≤0.01) and Digit Span Test (DST) forward (rs = −0.605; p ≤0.01), as well as a high inter-rater reliability (diagnostic k = 1.00; single items’ k between 0.65 and 1.00).Conclusion:Robust results on concurrent and convergent validity and good reliability were achieved. This version was shown to be a valid and reliable instrument for delirium detection in elderly patients hospitalized in intermediate care units.

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INCIDENCE, RISK FACTORS AND IMPACT ON OUTCOME IN OBSERVATIONAL STUDY OF DELIRIUM IN CARDIAC ICU.

10.36106/ijsr/3230983 ◽

2021 ◽

pp. 36-39

Author(s):

Rohan Ainchwar ◽

Harshawardhan Dhanraj Ramteke ◽

Saniya Sheikh

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Mechanical Ventilation ◽

Observational Study ◽

Confusion Assessment Method ◽

Assessment Method ◽

Cardiac Intensive Care Unit ◽

Confusion Assessment ◽

Incidence Risk ◽

Cardiac Intensive Care

Introduction: Many Patients admitted to Cardiac ICU (CICU) are easily prone to Delirium, that can lead to potentially severe consequences like Cognitive Impairment and increased risks of mortality. Delirium depends on the duration of hospital stay and discharge, contrary mainly affected to the patients on mechanical ventilation, which becomes the potential reason for longer duration. Studies suggest, Delirium is a widely discussed topic, when comes to the management of the patient in Cardiac ICU. During the Rounds, it is mandatory to focus on the diagnosis of delirium and must be validated using Confusion Assessment Method (CAM). These methods not only prevent the risk of the delirium and also enhances the use of the other preventive measures like the basis of the treatment, environmental factors, quiet time, sleep promotion, family support, communication with the patient, pain and dyspnea. When conrmed with delirium, pharmacological prophylaxis must be used as soon as possible. Most often, communication between Doctor, Nurse and Patient drives the most of the depression and acute delirium, but when delirium becomes critical with severe agitation or weaning from invasive mechanical ventilation. Thus, it is very important to identify the risk, complexity of the patients and clinical case scenarios of delirium in Cardiac ICU. Strategic Efforts were done to improve the identication of the patient at risk during admission, during stay at Cardiac ICU and during discharge and orders to improve the mental state of delirium patient. In this article, we provide a panorama of the incidence, risk factors, and impact on outcome of delirium in a Cardiac Intensive Care Unit (CICU). Methods: In this case study, total of 211 patients were observed for sign and symptoms in Cardiac ICU for Delirium. We aimed to determine the incidence, risk factors, and impact on outcome of delirium in a Cardiac Intensive Care Unit (CICU) in CHLMultispeciality Hospital and Research Center, Chandrapur using a prospective observational study. Patients:All consecutive patients admitted to the CICU between April 2021 and June 2021 were included if they were aged more than 18 years, had an CICU stay of more than 24 h and no psychiatric history. Patients eligible for the study were evaluated by the medical staff to detect delirium using the CAM. Results: In a 3-month period, 211 Patients were admitted in Cardiac ICU of CHLMultispeciality Hospital and Research Center. Out of which 198 were included in our observational study. The incidence of delirium at the end of the study was 21%. The number of delirious patients were 43 and non-delirious were 155. Age played an Important factor where 86% of Delirious patients were old aged. The LOS (Length of Stay) for Delirious and non-delirious patients were 6±1 vs 5±1 respectively. The SAS (Riker Agitation Scale) has the value of 4±1 vs 3±0.5, CAM (Confusion Assessment Method) has the value of 6±1 vs 3±1 and DDS (Delirium Detection Score) was 5±1 vs 3±1 for delirious vs non-delirious patients. The SAPS II (Simplied Acute Physiology Score II) Score for delirious patients was 23±1 and 20±2. The Incidences like Removal of Catheters were more frequent in this study with 20% in delirious patients and <1% Incidence in non-delirious patients. Removal of ET Tube had the Incidence of 5% vs <1%, Removal of Urinary Catheter 7% vs <1%, Removal of Ryle's Tube 7% vs <1%, respectively for delirious vs non-delirious patients.

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Effect of heart failure on postoperative short and long-term mortality in elderly patients with hip fracture

Injury ◽

10.1016/j.injury.2020.01.004 ◽

2020 ◽

Vol 51 (3) ◽

pp. 694-698 ◽

Cited By ~ 2

Author(s):

Yong-Han Cha ◽

Yong-Chan Ha ◽

Hyun-Jun Ryu ◽

Young-Kyun Lee ◽

Sang Hyun Park ◽

...

Keyword(s):

Heart Failure ◽

Hip Fracture ◽

Elderly Patients ◽

Short And Long Term ◽

Long Term Mortality

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Hemoglobin Concentration and Post-Operative Delirium in Elderly Patients Undergoing Femoral Neck Fracture Surgery

Frontiers in Medicine ◽

10.3389/fmed.2021.780196 ◽

2022 ◽

Vol 8 ◽

Author(s):

Yu-Mei Liu ◽

Hui Huang ◽

Jie Gao ◽

Jian Zhou ◽

Hai-Chen Chu

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Femoral Neck ◽

Elderly Patients ◽

Confusion Assessment Method ◽

Assessment Method ◽

Confusion Assessment ◽

Neck Fracture ◽

Icu Transfer ◽

Hb Concentration

This study aimed to determine the relationship between hemoglobin (Hb) concentration and post-operative delirium (POD) in elderly patients undergoing femoral neck fracture (FNF) surgery and to investigate whether the change in Hb concentration is associated with POD and the risk factors for POD. A total of 889 patients admitted with FNF between January 2016 and December 2020 were enrolled in this single-center, retrospective, case–control study. Hb concentrations were determined at admission and post-operative day 1 and the change in Hb concentration was defined as the absolute value of difference in pre-operative and post-operative Hb concentration. POD was assessed using the Confusion Assessment Method for the Intensive Care Unit (ICU) or the Confusion Assessment Method once a daily after surgery. The logistic regression analysis was performed for statistical analysis. In total, 172 (19.3%) patients developed POD and 151 (87.8%) patients developed POD within post-operative 3 days. Low pre-operative Hb concentration [p = 0.026, odds ratio (OR) = 0.978] and significant change in Hb concentration (p = 0.006, OR = 1.033) were significantly associated with POD. After excluding change in Hb concentration or pre-operative Hb concentration, neither of them was significantly associated with POD (p > 0.05). The interaction analysis of change in Hb concentration and pre-operative Hb concentration in the logistic regression model was negative. There was no significant relationship between post-operative Hb concentration and POD. Age (p < 0.001, OR = 1.072), stroke history (p = 0.003, OR = 2.489), post-operative ICU transfer (p = 0.007, OR = 1.981), and visual analog scale score within post-operative 2 days (p1 = 0.016 and p2 = 0.006) were independently associated with POD in the logistic regression analysis. Patients with low pre-operative Hb concentrations and high changes in Hb concentration seem to have an increased risk of POD and should receive more attention. Old age, stroke history, post-operative ICU transfer, and pain within post-operative 2 days were significantly associated with POD.

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Impact of percutaneous coronary intervention on short and long-term prognosis of elderly patients with acute myocardial infarction from 2010 to 2017 in Japanese population

European Heart Journal ◽

10.1093/ehjci/ehaa946.1625 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

J Goto ◽

T Watanabe ◽

Y Kobayashi ◽

T Toshima ◽

M Wanezaki ◽

...

Keyword(s):

Elderly Patients ◽

Coronary Intervention ◽

Short Term ◽

Percutaneous Coronary ◽

Short Term Mortality ◽

Short And Long Term ◽

Group 3 ◽

Long Term Prognosis ◽

Long Term Mortality

Abstract Background Advances in therapies have successfully decreased short-term mortality in patients with acute myocardial infarction (AMI). Although aging population is recently increasing in developed countries, there are few reports about the association between prevalence of percutaneous coronary intervention (PCI) and long-term prognosis in elderly patients with AMI in Japan. Purpose The aim of this study was to clarify the prevalence of PCI and the impact of PCI on short and long-term prognosis of elderly patients with AMI. Methods and results We investigated the prevalence of PCI and short-term mortality in 4,109 patients with AMI who were registered in Yamagata AMI Registry from 2010 to 2017. Long-term mortality was investigated using data from death certification in July 2019. We divided patients with AMI into three age groups (group 1, <65 years old; group 2, 65–79 years old; and group 3, ≥80 years old). Short-term mortality within 30 days was 6.5%, 12.1%, and 28.6%, respectively. Also, prevalence of PCI was 88.0%, 84.7%, and 62.7%, respectively. Multivariate analysis revealed that age, PCI, and severity of Killip classification were significantly associated with short-term mortality after adjustment for confound factors in group 3. Since the prevalence of PCI in group 3 was the lowest among three groups, the cause of PCI not being executed was investigated in 1,429 patients aged ≥80 years old. Elderly patients who didn't undergo PCI was older, more women, and had higher prevalence of chronic kidney disease, previous stroke, and severe Killip classification. Multivariate analysis revealed that age and Killip III/IV were significantly associated with non-executed PCI after adjustment for confound factors. Next, we investigated impact of PCI on long-term mortality in elderly patients who escaped acute death. Multivariate Cox hazard analysis revealed that PCI was associated with lower mortality after adjustment for confound factors (adjusted hazard ratio 2.47, 95% CI: 1.47–4.06; p=0.0008). Conclusion Lower prevalence of PCI and higher short-term mortality were observed in elderly patients with AMI aged ≥80 years old. PCI ameliorated long-term mortality as well as short-term mortality in elderly patients with AMI. Funding Acknowledgement Type of funding source: None

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Association Between Albumin Level and Mortality Among Cardiac Intensive Care Unit Patients

Journal of Intensive Care Medicine ◽

10.1177/0885066620963875 ◽

2020 ◽

pp. 088506662096387

Author(s):

Mitchell Padkins ◽

Thomas Breen ◽

Nandan Anavekar ◽

Gregory Barsness ◽

Kianoush Kashani ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Hospital Mortality ◽

Albumin Level ◽

Post Discharge ◽

Cardiac Intensive Care Unit ◽

Short And Long Term ◽

Cardiac Intensive Care ◽

Long Term Mortality

Purpose: To study the effect of hypoalbuminemia on short- and long-term mortality in Cardiac Intensive Care Unit (CICU) patients. Methods: We reviewed 12,418 unique CICU patients from 2007 to 2018. Hypoalbuminemia was defined as an admission albumin level <3.5 g/dL. Predictors of hospital mortality were identified using multivariable logistic regression. Results: We included 2,680 patients (22%) with a measured admission albumin level. The median age was 68 (39% females). Admission diagnoses included acute coronary syndrome, heart failure, cardiac arrest, and cardiogenic shock. The median albumin level was 3.4 g/dL and 55% of patients had hypoalbuminemia. Hospital mortality occurred in 16%, and patients with hypoalbuminemia had higher hospital mortality (21% vs. 9%, adjusted OR 2.64, 95% CI 2.09-3.34, p < 0.001). Albumin level was inversely associated with hospital mortality (adjusted OR 0.60 per 1 g/dL higher albumin level, 95% CI 0.47-0.75, p <0.001), with a stepwise increase in the hospital mortality at lower albumin levels. Post-discharge mortality was higher in hospital survivors with hypoalbuminemia, and increased as a function of lower albumin levels. Conclusion: Hypoalbuminemia is common in CICU patients and associated with higher short- and long-term mortality. Progressively lower serum albumin was incrementally associated with higher hospital and post-discharge mortality.

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