Abstract
ObjectiveTo identify risk factors for delirium among hospitalized patients in Zambia.MethodsWe conducted a prospective cohort study at the University Teaching Hospital in Lusaka, Zambia, from October 2017 to April 2018. We report associations of exposures including sociodemographic and clinical factors with delirium over the first three days of hospital admission, assessed using a modified Brief Confusion Assessment Method (bCAM).Findings749 patients were included for analysis (mean age, 42.9 years; 64.8% men; 47.3% with HIV). In individual regression analyses of potential delirium risk factors adjusted for age, sex and education, factors significantly associated with delirium included being divorced/widowed (OR 1.64, 95% CI 1.09–2.47), lowest tercile income (OR 1.58, 95% CI 1.04–2.40), informal employment (OR 1.97, 95% CI 1.25–3.15), untreated HIV infection (OR 2.18, 95% CI 1.21–4.06), unknown HIV status (OR 2.90, 95% CI 1.47–6.16), history of stroke (OR 2.70, 95% CI 1.15–7.19), depression/anxiety (OR 1.52, 95% CI 1.08–2.14), alcohol overuse (OR 1.96, 95% CI 1.39–2.79), sedatives ordered on admission (OR 3.77, 95% CI 1.70–9.54), severity of illness (OR 2.00, 95% CI 1.82–2.22), neurological (OR 7.66, 95% CI 4.90–12.24) and pulmonary-system admission diagnoses (OR 1.91, 95% CI 1.29–2.85), and sepsis (OR 2.44, 95% CI 1.51–4.08). After combining significant risk factors into a multivariable regression analysis, severity of illness, history of stroke, and being divorced/widowed remained predictive of delirium (p<0.05).ConclusionAmong hospitalized adults at a national referral hospital in Zambia, severity of illness, history of stroke, and being divorced/widowed were independently predictive of delirium. Extension of this work will inform future efforts to prevent, detect, and manage delirium in low- and middle-income countries.
Highlights
Delirium is a potentially modifiable form of acute neurologic dysfunction that is common among hospitalized patients, with high rates among intensive care unit (ICU) patients [1]
Delirium is considered a serious issue of public health importance among hospitalized patients in high-income countries (HICs) [7,8], limited information exists about risk factors for delirium in low- and middle-income countries (LMICs)
Delirium prevalence at enrollment was 47.0% in the primary cohort versus 43.6% in the seven-day point prevalence study
Summary
Delirium is a potentially modifiable form of acute neurologic dysfunction that is common among hospitalized patients, with high rates among intensive care unit (ICU) patients [1]. Studies in high-income countries (HICs) have identified both modifiable and non-modifiable risk factors for delirium [1]. Elucidation of these risk factors has informed the development of effective evidence-based strategies for preventing delirium and associated poor clinical outcomes, within the ICU setting [7]. Delirium is considered a serious issue of public health importance among hospitalized patients in HICs [7,8], limited information exists about risk factors for delirium in low- and middle-income countries (LMICs)
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