Abstract P390: Prediction Enhancement of the Post-Stroke Delirium by Adding of the Brain Lesional Characteristics to the Clinical Features in Acute Ischemic Stroke Patients

Abstract

Background: We evaluated whether the brain regional features could enhance the prediction of the occurrence of the post-stroke delirium along with consideration of clinical features in acute ischemic stroke patients. Method: We analyzed magnetic resonance imaging and clinical datasets prospectively collected from 1,024 acute ischemic stroke patients (620 men; mean age±SD, 70.2±11.8 years), who were admitted in stroke unit. Delirium occurrence in the patients was initially screened with Confusion Assessment Method and finally diagnosed using the criteria of the Diagnostic and Statistical Manual of Mental Disorders (fifth edition). The prediction performance of the clinical features was evaluated using the logistic regression analysis, and then, compared with the performance obtained after adding of the brain lesional features. Results: Post-stroke delirium occurred in 100 (9.8%) of the total patients. Independent features of the clinical features were old age (odds ratio [OR] for the delirium prediction: 1.07, 95% confidence interval [CI] 1.038-1.103), preexisting dementia (OR 0.423, CI 0.209-0.853) and atrial fibrillation OR 1.599, CI 0.938-2.726), neglect (OR 2.395, CI 1.152-4.976), visual defect (OR 2.209, CI 0.994-4.907), diplopia (OR 2.42, CI 1.021-5.738), dysuria (OR 2.404, 95% CI 1.155-5.000), Foley catheter insertion (OR 0.46, CI 0.24-0.881) and pneumonia (OR 1.954, CI 1.004-3.803). Right-sided hemispheric and mixed acute lesions (p=0.003), lesion locations in occipital lobe (OR 1.814, CI 0.923-3.564), cerebellum (OR 2.875, CI 1.32-6.258) and brainstem (OR 4.057, CI 1.714-9.601), and the presence of the periventricular white matter change (OR 1.321, CI 0.964-1.811) increased the risk for delirium. Sensitivity to predict the delirium of the regression model was enhanced from 10% obtained with the clinical features to 18% by adding the brain lesional features. Area under the curve of the receiver operating characteristics analysis was also enhanced from 0.827 with the clinical features to 0.847 after adding the brain lesions to the clinical features. Conclusion: The present study shows brain lesional characteristics that could enhance the prediction of the post-stroke delirium in acute ischemic stroke patients.