Factors associated with delirium among survivors of acute respiratory distress syndrome: a nationwide cohort study

Tak Kyu Oh,Hye Youn Park,In-Ae Song

doi:10.1186/s12890-021-01714-0

Abstract

BackgroundThe prevalence of delirium, its associated factors, and its impact on long-term mortality among survivors of acute respiratory distress syndrome (ARDS) is unclear.MethodsSince this was a population-based study, data were extracted from the National Health Insurance database in South Korea. All adults who were admitted to intensive care units with a diagnosis of ARDS between January 1, 2010, and December 31, 2019, and who survived for ≥ 60 days were included. The International Statistical Classification of Diseases and Related Health Problems, tenth revision code of delirium (F05) was used to extract delirium cases during hospitalization.ResultsA total of 6809 ARDS survivors were included in the analysis, and 319 patients (4.7%) were diagnosed with delirium during hospitalization. In the multivariable logistic regression analysis after covariate adjustment, male sex (odds ratio [OR] 1.60, 95% confidence interval [CI] 1.23, 2.08; P < 0.001), longer duration of hospitalization (OR 1.02, 95% CI 1.01, 1.03; P < 0.001), neuromuscular blockade use (OR 1.50, 95% CI 1.12, 2.01; P = 0.006), benzodiazepine (OR 1.55, 95% CI 1.13, 2.13; P = 0.007) and propofol (OR 1.48, 95% CI 1.01, 2.17; P = 0.046) continuous infusion, and concurrent depression (OR 1.31, 95% CI 1.01, 1.71; P = 0.044) were associated with a higher prevalence of delirium among ARDS survivors. In the multivariable Cox regression analysis after adjustment for covariates, the occurrence of delirium was not significantly associated with 1-year all-cause mortality, when compared to the other survivors who did not develop delirium (hazard ratio: 0.85, 95% CI 1.01, 1.71; P = 0.044).ConclusionsIn South Korea, 4.7% of ARDS survivors were diagnosed with delirium during hospitalization in South Korea. Some factors were potential risk factors for the development of delirium, but the occurrence of delirium might not affect 1-year all-cause mortality among ARDS survivors.

Highlights

The prevalence of delirium, its associated factors, and its impact on long-term mortality among survi‐ vors of acute respiratory distress syndrome (ARDS) is unclear
A recent retrospective cohort study reported that 43% (124/286) of patients with ARDS were diagnosed with intensive care unit (ICU) delirium [12]
A total of 27,889 patients were admitted in the ICU and diagnosed with ARDS in South Korea

Summary

Introduction

The prevalence of delirium, its associated factors, and its impact on long-term mortality among survi‐ vors of acute respiratory distress syndrome (ARDS) is unclear. Delirium is a serious disturbance in mental abilities that results in an acute confusional status and deteriorating awareness of the environment [1]. For critically ill patients in the ICU, the reported prevalence of delirium is 25–31.8% [5, 6]. Studies on the relationship between delirium, risk factors, and mortality of patients with ARDS are few. A recent retrospective cohort study reported that 43% (124/286) of patients with ARDS were diagnosed with ICU delirium [12]. The prevalence and impact of delirium on long-term mortality during hospitalization among ARDS survivors have not yet been identified

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