scholarly journals Frailty, delirium and hospital mortality of older adults admitted to intensive care, a mediation analysis: the Delirium (Deli) in ICU study.

2020 ◽  
Author(s):  
David Sanchez ◽  
Kathleen Brennan ◽  
Masar El Safye ◽  
Sharon-Ann Shunker ◽  
Tony Bogdanoski ◽  
...  

Abstract Background As the population ages clinical frailty among older adults admitted to intensive care has been proposed as an important determinant of patient outcomes. Among this group of frail patients an acute episode of delirium is also common, and both frailty and delirium increase the risk of mortality. However, the complex relationship between frailty, delirium and mortality has not been extensively explored in the intensive care setting. Therefore, the aim of this study was to explore the relationship between clinical frailty, acute delirium and hospital mortality of older adults admitted to intensive care. Methods This study is part of a Delirium in Intensive Care (Deli) study that is being conducted across the South Western Sydney Local Health District, between May 2019 and April 2020. During the initial 6-month baseline period, clinical frailty status on admission to ICU, among adults aged 50-years or more, acute episodes of delirium, and the outcomes of ICU and hospital stay will be described. Mediation analysis was used to assess the relationship between frailty, delirium and risk of hospital death. Results During the 6-month baseline period 997 patients, aged 50-years or more, were included in this study. The average age was 71-years (IQR, 63–79), 55% were male (n = 537). Among these patients 39.2% (95% CI 36.1–42.3%, n = 396) had a Clinical Frailty Score (CFS) of 5 or more, and 13.0% (n = 127) had at least one acute episode of delirium. Frail patients were at greater risk of an episode of delirium (17% versus 10%, adjusted Rate Ratio (adjRR) = 1.61, 95% Confidence Interval (CI) 1.14–2.28, p = 0.007), had a longer hospital stay (2.6 days, 95% CI 1–7 days, p = 0.009), and higher risk of hospital mortality (19% versus 7%, adjRR = 2.43, 95% CI 1.68–3.57, p < 0.001), when compared to non-frail patients. Patients who were frail and experienced an acute episode of delirium in the ICU had a 35% rate of hospital mortality, versus 10% among non-frail patients who also experienced delirium in the ICU (p = 0.034, for interaction between frailty, delirium and hospital mortality). The proportion of the effect of frailty and risk of hospital mortality mediated by an acute episode of delirium in the ICU was estimated to 9.4% (95% CI 2–24%). Conclusion This study has been able to show that clinical frailty on admission increases the risk of delirium by approximately 60%, and both increase the risk of hospital mortality. One in three frail patients who experienced an acute episode of delirium during their stay in the ICU did not survive to hospital discharge. These results suggest the importance of recognising clinical frailty in the ICU setting, not just to improve the prediction of outcomes from critical illness, but to identify patients at the greatest risk of adverse events such as delirium, and institute measures to reduce risk, and, importantly to discuss these issues in an open and empathetic way with the patient and their families.

2020 ◽  
Author(s):  
David Sanchez ◽  
Kathleen Brennan ◽  
Masar El Safye ◽  
Sharon-Ann Shunker ◽  
Tony Bogdanoski ◽  
...  

Abstract Background: As the population ages clinical frailty among older adults admitted to intensive care has been proposed as an important determinant of patient outcomes. Among this group of patients an acute episode of delirium is also common, but its relationship to frailty and increased risk of mortality has not been extensively explored. Therefore, the aim of this study was to explore the relationship between clinical frailty, delirium and hospital mortality of older adults admitted to intensive care.Methods: This study is part of a Delirium in Intensive Care (Deli) study that is being conducted across the SWSLHD between May 1st 2019 and the end of April 2020. During the initial 6-month baseline period, clinical frailty status on admission to intensive care, among adults aged 50-years or more, acute episodes of delirium, and the outcomes of intensive care and hospital stay will be described. Mediation analysis was used to assess the relationship between frailty and increased risk of hospital death and delirium.Results: During the 6-month baseline period 997 patients, aged 50-years or more, were included in this study. The average age was 71-years (IQR, 63-79), 55% were male (n = 537). Among these patients 39.2% (95% CI 36.1 – 42.3%, n = 396) had a Clinical Frailty Score (CFS) of 5 or more, and 13.0% (n=127) had at least one acute episode of delirium. Frail patients were at greater risk of an episode of delirium (17% versus 10%, adjusted Rate Ratio (adjRR) = 1.61, 95% Confidence Interval (CI) 1.14 – 2.28, p = 0.007), had a longer hospital stay (2.6 days, 95% CI 1-7 days, p = 0.009), and higher risk of hospital mortality (19% versus 7%, adjRR = 2.43, 95% CI 1.68 – 3.57, p < 0.001), when compared to non-frail patients. Patients who were frail and experienced an acute episode of delirium in the intensive care had a 35% rate of hospital mortality, versus 10% among non-frail patients who also experienced delirium in the ICU (p = 0.034, for interaction between frailty, delirium and hospital mortality). The proportion of the effect of frailty and risk of hospital mortality mediated by an acute episode of delirium in the ICU was estimated to 9.4% (95% CI 2 – 24%).Conclusion: This study among adults, aged 50-years or more, admitted to intensive care has been able to show that clinical frailty on admission increases the risk of delirium by approximately 60%, and both increase the risk of hospital mortality. One in three frail patients who experienced an acute episode of delirium during their stay in the intensive care did not survive to hospital discharge. These results suggest the importance of recognising clinical frailty in the intensive care setting, not just to improve the prediction of outcomes from critical illness, but to identify patients at the greatest risk of adverse events such as delirium, and institute measures to reduce risk, and, importantly to discuss these issues in an open and empathetic way with the patient and their families.


2020 ◽  
Author(s):  
David Sanchez ◽  
Kathleen Brennan ◽  
Masar El Safye ◽  
Sharon-Ann Shunker ◽  
Tony Bogdanoski ◽  
...  

Abstract Background: As the population ages clinical frailty among older adults admitted to intensive care has been proposed as an important determinant of patient outcomes. Among this group of patients an acute episode of delirium is also common, but its relationship to frailty and increased risk of mortality has not been extensively explored. Therefore, the aim of this study was to explore the relationship between clinical frailty, delirium and hospital mortality of older adults admitted to intensive care.Methods: This study is part of a Delirium in Intensive Care (Deli) study that is being conducted across the SWSLHD between May 1st 2019 and the end of April 2020. During the initial 6-month baseline period, clinical frailty status on admission to intensive care, among adults aged 50-years or more, acute episodes of delirium, and the outcomes of intensive care and hospital stay will be described.Results: During the 6-month baseline period 997 patients, aged 50-years or more, were included in this study. The average age was 71-years (IQR, 63-79), 55% were male (n = 537). Among these patients 39.2% (95% CI 36.1 – 42.3%, n = 396) had a Clinical Frailty Score (CFS) of 5 or more, and 13.0% (n=127) had at least one acute episode of delirium. Frail patients were at greater risk of an episode of delirium (17% versus 10%, adjusted Rate Ratio (adjRR) = 1.71, 95% Confidence Interval (CI) 1.20 – 2.43, p = 0.003), had a longer hospital stay (2.6 days, 95% CI 1-7 days, p = 0.009), and higher risk of hospital mortality (19% versus 7%, adjRR = 2.54, 95% CI 1.72 – 3.75, p < 0.001), when compared to non-frail patients. Patients who were frail and experienced an acute episode of delirium in the intensive care had a 35% rate of hospital mortality, versus 10% among non-frail patients who also experienced delirium in the ICU.Conclusion: We have been able to show that among older frail admissions to intensive care, not just delirium, but hospital mortality is high. Importantly, we have found that approximately one in three frail patients who experienced an acute episode of delirium during their stay in the intensive care did not survive to hospital discharge. These results suggest the importance of recognising clinical frailty in the intensive care setting, not just to improve the prediction of outcomes from critical illness, but to identify patients at the greatest risk of adverse events such as delirium, and institute measures to reduce risk, and, importantly to discuss these issues in an open and empathetic way with the patient and their families.


Critical Care ◽  
2020 ◽  
Vol 24 (1) ◽  
Author(s):  
David Sanchez ◽  
Kathleen Brennan ◽  
Masar Al Sayfe ◽  
Sharon-Ann Shunker ◽  
Tony Bogdanoski ◽  
...  

Abstract Background Clinical frailty among older adults admitted to intensive care has been proposed as an important determinant of patient outcomes. Among this group of patients, an acute episode of delirium is also common, but its relationship to frailty and increased risk of mortality has not been extensively explored. Therefore, the aim of this study was to explore the relationship between clinical frailty, delirium and hospital mortality of older adults admitted to intensive care. Methods This study is part of a Delirium in Intensive Care (Deli) Study. During the initial 6-month baseline period, clinical frailty status on admission to intensive care, among adults aged 50 years or more; acute episodes of delirium; and the outcomes of intensive care and hospital stay were explored. Results During the 6-month baseline period, 997 patients, aged 50 years or more, were included in this study. The average age was 71 years (IQR, 63–79); 55% were male (n = 537). Among these patients, 39.2% (95% CI 36.1–42.3%, n = 396) had a Clinical Frailty Score (CFS) of 5 or more, and 13.0% (n = 127) had at least one acute episode of delirium. Frail patients were at greater risk of an episode of delirium (17% versus 10%, adjusted rate ratio (adjRR) = 1.71, 95% confidence interval (CI) 1.20–2.43, p = 0.003), had a longer hospital stay (2.6 days, 95% CI 1–7 days, p = 0.009) and had a higher risk of hospital mortality (19% versus 7%, adjRR = 2.54, 95% CI 1.72–3.75, p < 0.001), when compared to non-frail patients. Patients who were frail and experienced an acute episode of delirium in the intensive care had a 35% rate of hospital mortality versus 10% among non-frail patients who also experienced delirium in the ICU. Conclusion Frailty and delirium significantly increase the risk of hospital mortality. Therefore, it is important to identify patients who are frail and institute measures to reduce the risk of adverse events in the ICU such as delirium and, importantly, to discuss these issues in an open and empathetic way with the patient and their families.


2020 ◽  
Author(s):  
David Sanchez ◽  
Kathleen Brennan ◽  
Masar El Safye ◽  
Sharon-Ann Shunker ◽  
Tony Bogdanoski ◽  
...  

Abstract Background: Clinical frailty among older adults admitted to intensive care has been proposed as an important determinant of patient outcomes. Among this group of patients an acute episode of delirium is also common, but its relationship to frailty and increased risk of mortality has not been extensively explored. Therefore, the aim of this study was to explore the relationship between clinical frailty, delirium and hospital mortality of older adults admitted to intensive care.Methods: This study is part of a Delirium in Intensive Care (Deli) study. During the initial 6-month baseline period, clinical frailty status on admission to intensive care, among adults aged 50-years or more, acute episodes of delirium, and the outcomes of intensive care and hospital stay were explored.Results: During the 6-month baseline period 997 patients, aged 50-years or more, were included in this study. The average age was 71-years (IQR, 63-79), 55% were male (n = 537). Among these patients 39.2% (95% CI 36.1 – 42.3%, n = 396) had a Clinical Frailty Score (CFS) of 5 or more, and 13.0% (n=127) had at least one acute episode of delirium. Frail patients were at greater risk of an episode of delirium (17% versus 10%, adjusted Rate Ratio (adjRR) = 1.71, 95% Confidence Interval (CI) 1.20 – 2.43, p = 0.003), had a longer hospital stay (2.6 days, 95% CI 1-7 days, p = 0.009), and higher risk of hospital mortality (19% versus 7%, adjRR = 2.54, 95% CI 1.72 – 3.75, p < 0.001), when compared to non-frail patients. Patients who were frail and experienced an acute episode of delirium in the intensive care had a 35% rate of hospital mortality, versus 10% among non-frail patients who also experienced delirium in the ICU.Conclusion: Frailty and delirium significantly increase the risk of hospital mortality. Therefore, it important to identify patients who are frail and institute measures to reduce the risk of adverse events in the ICU such as delirium. And, importantly to discuss these issues in an open and empathetic way with the patient and their families.


2020 ◽  
Author(s):  
David Sanchez ◽  
Kathleen Brennan ◽  
Masar El Safye ◽  
Sharon-Ann Shunker ◽  
Tony Bogdanoski ◽  
...  

Abstract Background: As the population ages clinical frailty among older adults admitted to intensive care has been proposed as an important determinant of patient outcomes. Among this group of patients an acute episode of delirium is also common, but its relationship to frailty and increased risk of mortality has not been extensively explored. Therefore, the aim of this study was to explore the relationship between clinical frailty, delirium and hospital mortality of older adults admitted to intensive care.Methods: This study is part of a Delirium in Intensive Care (Deli) study that is being conducted across the SWSLHD between May 1st 2019 and the end of April 2020. During the initial 6-month baseline period, clinical frailty status on admission to intensive care, among adults aged 50-years or more, acute episodes of delirium, and the outcomes of intensive care and hospital stay will be described.Results: During the 6-month baseline period 997 patients, aged 50-years or more, were included in this study. The average age was 71-years (IQR, 63-79), 55% were male (n = 537). Among these patients 39.2% (95% CI 36.1 – 42.3%, n = 396) had a Clinical Frailty Score (CFS) of 5 or more, and 13.0% (n=127) had at least one acute episode of delirium. Frail patients were at greater risk of an episode of delirium (17% versus 10%, adjusted Rate Ratio (adjRR) = 1.71, 95% Confidence Interval (CI) 1.20 – 2.43, p = 0.003), had a longer hospital stay (2.6 days, 95% CI 1-7 days, p = 0.009), and higher risk of hospital mortality (19% versus 7%, adjRR = 2.54, 95% CI 1.72 – 3.75, p < 0.001), when compared to non-frail patients. Patients who were frail and experienced an acute episode of delirium in the intensive care had a 35% rate of hospital mortality, versus 10% among non-frail patients who also experienced delirium in the ICU.Conclusion: This study among adults, aged 50-years or more, admitted to intensive care has been able to show that clinical frailty on admission increases the risk of delirium by approximately 60%, and both increase the risk of hospital mortality. One in three frail patients who experienced an acute episode of delirium during their stay in the intensive care did not survive to hospital discharge. These results suggest the importance of recognising clinical frailty in the intensive care setting, not just to improve the prediction of outcomes from critical illness, but to identify patients at the greatest risk of adverse events such as delirium, and institute measures to reduce risk, and, importantly to discuss these issues in an open and empathetic way with the patient and their families.


Author(s):  
Leigh P. Fitzpatrick ◽  
Bianca Levkovich ◽  
Steve McGloughlin ◽  
Edward Litton ◽  
Allen C. Cheng ◽  
...  

Abstract Background ICU-specific tables of antimicrobial susceptibility for key microbial species (‘antibiograms’), antimicrobial stewardship (AMS) programmes and routine rounds by infectious diseases (ID) physicians are processes aimed at improving patient care. Their impact on patient-centred outcomes in Australian and New Zealand ICUs is uncertain. Objectives To measure the association of these processes in ICU with in-hospital mortality. Methods The Australian and New Zealand Intensive Care Society (ANZICS) Adult Patient Database and Critical Care Resources registry were used to extract patient-level factors, ICU-level factors and the year in which each process took place. Descriptive statistics and hierarchical logistic regression were used to determine the relationship between each process and in-hospital mortality. Results The study included 799 901 adults admitted to 173 ICUs from July 2009 to June 2016. The proportion of patients exposed to each process of care was 38.7% (antibiograms), 77.5% (AMS programmes) and 74.0% (ID rounds). After adjusting for confounders, patients admitted to ICUs that used ICU-specific antibiograms had a lower risk of in-hospital mortality [OR 0.95 (99% CI 0.92–0.99), P = 0.001]. There was no association between the use of AMS programmes [OR 0.98 (99% CI 0.94–1.02), P = 0.16] or routine rounds with ID physicians [OR 0.96 (99% CI 0.09–1.02), P = 0.09] and in-hospital mortality. Conclusions Use of ICU-specific antibiograms was associated with lower in-hospital mortality for patients admitted to ICU. For hospitals that do not perform ICU-specific antibiograms, their implementation presents a low-risk infection management process that might improve patient outcomes.


2017 ◽  
Vol 126 (5) ◽  
pp. 799-809 ◽  
Author(s):  
Ryu Komatsu ◽  
Huseyin Oguz Yilmaz ◽  
Jing You ◽  
C. Allen Bashour ◽  
Shobana Rajan ◽  
...  

Abstract Background Statins may reduce the risk of pulmonary and neurologic complications after cardiac surgery. Methods The authors acquired data for adults who had coronary artery bypass graft, valve surgery, or combined procedures. The authors matched patients who took statins preoperatively to patients who did not. First, the authors assessed the association between preoperative statin use and the primary outcomes of prolonged ventilation (more than 24 h), pneumonia (positive cultures of sputum, transtracheal fluid, bronchial washings, and/or clinical findings consistent with the diagnosis of pneumonia), and in-hospital all-cause mortality, using logistic regressions. Second, the authors analyzed the collapsed composite of neurologic complications using logistic regression. Intensive care unit and hospital length of stay were evaluated with Cox proportional hazard models. Results Among 14,129 eligible patients, 6,642 patients were successfully matched. There was no significant association between preoperative statin use and prolonged ventilation (statin: 408/3,321 [12.3%] vs. nonstatin: 389/3,321 [11.7%]), pneumonia (44/3,321 [1.3%] vs. 54/3,321 [1.6%]), and in-hospital mortality (52/3,321 [1.6%] vs. 43/3,321 [1.3%]). The estimated odds ratio was 1.06 (98.3% CI, 0.88 to 1.27) for prolonged ventilation, 0.81 (0.50 to 1.32) for pneumonia, and 1.21 (0.74 to 1.99) for in-hospital mortality. Neurologic outcomes were not associated with preoperative statin use (53/3,321 [1.6%] vs. 56/3,321 [1.7%]), with an odds ratio of 0.95 (0.60 to 1.50). The length of intensive care unit and hospital stay was also not associated with preoperative statin use, with a hazard ratio of 1.04 (0.98 to 1.10) for length of hospital stay and 1.00 (0.94 to 1.06) for length of intensive care unit stay. Conclusions Preoperative statin use did not reduce pulmonary or neurologic complications after cardiac surgery.


2021 ◽  
Author(s):  
Guangyao Zhai ◽  
Biyang Zhang ◽  
Jianlong Wang ◽  
Yuyang Liu ◽  
Yujie Zhou

Abstract Background: It has been discovered that both inflammation and platelet aggregation could cause crucial effect on the occurrence and development of cardiovascular diseases. As a combination of platelet and lymphocyte, platelet-lymphocyte ratio (PLR) was proved to be correlated with the severity as well as prognosis of cardiovascular diseases. Exploring the relationship between PLR and in-hospital mortality in cardiac intensive care unit (CICU) patients was the purpose of this study. Method: PLR was calculated by dividing platelet count by lymphocyte count. All patients were grouped by PLR quartiles and the primary outcome was in-hospital mortality. The independent effect of PLR was determined by binary logistic regression analysis. The curve in line with overall trend was drawn by local weighted regression (Lowess). Subgroup analysis was used to determine the relationship between PLR and in-hospital mortality in different subgroups. Result: We included 5577 CICU patients. As PLR quartiles increased, in-hospital mortality increased significantly (Quartile 4 vs Quartile 1: 13.9 vs 8.3, P <0.001). After adjusting for confounding variables, PLR was proved to be independently associated with increased risk of in-hospital mortality (Quartile 4 vs Quartile 1: OR, 95% CI: 1.99, 1.46-2.71, P<0.001, P for trend <0.001). The Lowess curves showed a positive relationship between PLR and in-hospital mortality. The subgroup analysis revealed that patients with low Acute Physiology and Chronic Health Evaluation IV (APACHE IV) or with less comorbidities had higher risk of mortality for PLR. Further, PLR quartiles had positive relation with length of CICU stay (Quartile 4 vs Quartile 1: 2.7, 1.6-5.2 vs 2.1, 1.3-3.9, P<0.001), and the length of hospital stay (Quartile 4 vs Quartile 1: 7.9, 4.6-13.1 vs 5.8, 3.3-9.8, P<0.001). Conclusion: PLR was independently associated with in-hospital mortality in CICU patients.


2021 ◽  
Author(s):  
İbrahim Saraç ◽  
Gökhan Tonkaz ◽  
Emrah Aksakal ◽  
Faruk Aydınyılmaz ◽  
Kaan Alişar ◽  
...  

Abstract Purpose In our study, we investigated the relationship between pneumonia severity and pericardial effusion, predisposing factors and the effect of pericardial effusion on clinical prognosis and mortality in COVID-19 patients. Methods A total of 3794 patients who were diagnosed with COVID- 19 by polymerase chain reaction (PCR), were hospitalized between March 21 and November 30, 2020 were included in the study. For each of the 3794 patients, the initial chest CT images, pericardial efusion (PE), pleural efusion and pneumonia severity were evaluated. Results The mean age of patients with PE was higher and it was more common in males. Patients with PE had more comorbid diseases and significantly elevated serum cardiac and inflammatory biomarkers. In addition, the need for intensive care and mortality rates were higher in these patients. While the in-hospital mortality rate was 56.9% in patients with PE and AC involvement above 50%, in-hospital mortality rate was 34.4% in patients with AC involvement above 50% and without PE (p < 0.001). Conclusions In patients presenting with severe AC involvement on CT or being followed up with COVID-19 pneumonia, PE often accompanies the deterioration in the laboratories and clinics of the patients. The clinical prognosis in patients presenting with PE was quite poor, and the frequency of intensive care admissions and mortality were significantly higher. In conclusion, in our study, PE emerged as an important finding in the follow-up and management of patients with COVID-19 and reflects the clinical prognosis.


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