Abstract
BackgroundThe incidence of delirium in intensive care unit (ICU) patients is high and associated with a poor prognosis. We validated the risk factors of delirium to identify relevant early and predictive clinical indicators and developed an optimized model.MethodsIn the derivation cohort, 223 patients were assigned to two groups (with or without delirium) based on the CAM-ICU results. Multivariate logistic regression analysis was conducted to identify independent risk predictors, and the accuracy of the predictors was then validated in a prospective cohort of 81 patients.ResultsA total of 304 patients were included: 223 in the derivation group and 81 in the validation group, 64(21.1%)developed delirium. The model consisted of six predictors assessed at ICU admission: history of hypertension (RR = 4.367; P = 0.020), hypoxaemia (RR = 3.382; P = 0.018), use of benzodiazepines (RR = 5.503; P = 0.013), deep sedation (RR = 3.339; P = 0.048), sepsis (RR = 3.480; P = 0.018) and mechanical ventilation (RR = 3.547; P = 0.037). The mathematical model predicted ICU delirium with an accuracy of 0.862 (P < 0.001) in the derivation cohort and 0.739 (P < 0.001) in the validation cohort. No significant difference was found between the predicted and observed cases of ICU delirium in the validation cohort (P > 0.05).ConclusionsPatients’ risk of delirium can be predicted at admission using the early prediction score, allowing the implementation of early preventive interventions aimed to reduce the incidence and severity of ICU delirium.
Highlights
Delirium is a disturbance of consciousness characterized by an acute onset and a fluctuating course of impaired cognitive functioning
The cohort consisted of 304 patients, 223 of whom were allocated to the derivation cohort (September 2015 to January 2016) while the remaining 81 patients were allocated to the validation cohort (February 2016 to April 2016)
We found a 21.1% incidence of delirium in critically ill patients, which is consistent with Von Rueden’s finding [15] of a 24% incidence of delirium after trauma but is lower than the rate after liver transplantation reported by Beckmann [16]
Summary
Delirium is a disturbance of consciousness characterized by an acute onset and a fluctuating course of impaired cognitive functioning. Correlational research [12] suggested that screening could increase the rate of its diagnosis to 64%, and the early essential intervention could reduce both the incidence of delirium and its duration and complications. This highlights the importance of evaluating the performance of such models which based on identified risk factors for delirium in ICU patients. We validated the risk factors of delirium to identify relevant early and predictive clinical indicators and developed an optimized model
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