Abstract WMP99: In-Hospital Delirium and Long-Term Cognitive Outcomes Among Patients With Intracerebral Hemorrhage: A Population-Based Cohort Analysis

Abstract

Introduction: Little is known regarding the association between acute in-hospital exposures such as delirium and long-term cognitive outcomes in intracerebral hemorrhage (ICH) patients. We sought to explore the risk of mild cognitive impairment or dementia (MCID) among ICH patients who experienced in-hospital delirium. Methods: We utilized State Inpatient and Emergency Department Databases for NY (2006 - 2014), CA (2005 - 2011), and FL (2005 - 2014), and established a cohort by selecting MCID free patients with a primary diagnosis of ICH (ICD-9: 431) during a 2yr period. Patients with concurrent diagnoses of head trauma, arteriovenous malformation or missing linkage information were excluded. Delirium during the initial ICH event was tagged using a validated algorithm with high specificity for the confusion assessment method. The cohort was followed for MCID diagnoses. Patients that died within 90 days of ICH were excluded. We conducted time-to-event analyses and report cumulative incidence, 95% Confidence Interval (CI) and hazard ratios (HR) for risk of MCID among ICH patients with and without delirium. Results: A total of 18,083 ICH patients (age: 67.2, female: 47.6%, white: 59.1%) were included and were followed for up to 8yrs, resulting in 42,100 person-years. Patients who experienced delirium had a significantly higher comorbidity index and intensity of in-hospital treatment. Cumulative incidence (95% CI) for development of MCID was significantly higher among delirium patients (6.07, 5.05 - 7.30) as compared to non-delirium patients (4.07, 3.87 - 4.27). Likewise, the HR for MCID among delirium patients was statistically significant (1.42, 1.17 - 1.73) in the fully adjusted Cox proportional model (Figure). Conclusion: ICH patients with in-hospital delirium are at a significantly higher risk of developing MCID. Further investigation is warranted to understand the mechanism for cognitive decline among ICH patients who experience in-hospital delirium.