Added value of anxiolytic benzodiazepines in predictive models on severe delirium in patients with acute decompensated heart failure: A retrospective analysis.

Kei Kawada,Tomoaki Ishida,Kohei Jobu,Hiroko Fujita,Tsuyoshi Ohta,Manami Okamoto,Mitsuhiko Miyamura,Hitoshi Fukuda,Tetushi Kawazoe,Toru Kubo,Hiroaki Kitaoka,Shumpei Morisawa,Tetsuya Ueba,Yasuyo Morita,Pasquale Abete

doi:10.1371/journal.pone.0250372

Abstract

Delirium in patients with acute decompensated heart failure (ADHF) is associated with poor clinical outcomes. Although some medications have been reported as risk factors for delirium, their impact on patients with ADHF is still unclear. This study aimed to determine the association of specific medication use with delirium and their additive predictive value in models based on conventional risk factors. In this single-center, retrospective study, 650 patients treated for ADHF were included. Fifty-nine patients (9.1%) had delirium. In multivariate analysis, anxiolytic benzodiazepines [odds ratio (OR): 6.4, 95% confidence interval (CI): 2.8-15], mechanical ventilation or noninvasive positive pressure ventilation (OR: 6.0, 95% CI: 2.9-12), depression (OR: 3.2, 95% CI: 1.5-6.5), intensive care or high care unit admission (OR: 2.9, 95% CI: 1.5-5.6), male sex (OR: 2.0, 95% CI: 1-3.7), and age (OR: 1.1, 95% CI: 1-1.1) were independently associated with severe delirium. The predictive model that included anxiolytic benzodiazepines had a significantly better discriminatory ability for the incidence of severe delirium than the conventional model. The use of anxiolytic benzodiazepines was independently correlated with severe delirium, and their use in models based on conventional risk factors had an additive value for predicting delirium in patients with ADHF.

Highlights

The use of anxiolytic benzodiazepines was independently correlated with severe delirium, and their use in models based on conventional risk factors had an additive value for predicting delirium in patients with acute decompensated heart failure (ADHF)
Delirium is a common symptom in patients with acute decompensated heart failure (ADHF), and it is associated with prolonged hospitalization and increased morbidity and mortality [1,2]
Many medications have been associated with the development of delirium in surgical or intensive care unit (ICU) patients [4,5,6], only a few studies have demonstrated an association between the type of medication and the development of delirium in hospitalized patients with ADHF

Summary

Introduction

Delirium is a common symptom in patients with acute decompensated heart failure (ADHF), and it is associated with prolonged hospitalization and increased morbidity and mortality [1,2]. Specific patient characteristics and severity of heart failure (HF) have been posited as risk factors for delirium in patients with ADHF [1,2,3]. This study aimed to investigate the association between the use of specific medications and the development of delirium in patients with ADHF and to assess the discriminative performance of a novel outcome prediction model comprising conventional risk factors and medication use. Delirium in patients with acute decompensated heart failure (ADHF) is associated with poor clinical outcomes. This study aimed to determine the association of specific medication use with delirium and their additive predictive value in models based on conventional risk factors

Objectives

Methods

Results

Conclusion