BACKGROUND: Delirium has not been found to be a significant predictor of postdischarge mortality, but previous research has methodologic limitations including small sample sizes and inadequate control of confounding. This study aimed to determine the independent effects of presence of delirium, type of delirium (incident vs prevalent), and severity of delirium symptoms on 12-month mortality among older medical inpatients. METHODS: A prospective, observational study of 2 cohorts of medical inpatients was conducted with patients 65 years or older: 243 patients had prevalent or incident delirium, and 118 controls had no delirium. Baseline measures included presence of delirium and/or dementia, severity of delirium symptoms, physical function, comorbidity, and physiological and clinical severity of illness. Mortality during the 12 months after enrollment was analyzed with the Cox proportional hazards model with adjustment for covariates. RESULTS: The unadjusted hazard ratio of delirium with mortality was 3.44 (95% confidence interval, 2.05-5.75); the adjusted hazard ratio was 2.11 (95% confidence interval, 1.18-3.77). The effect of delirium was sustained over the entire 12-month period after adjustment for covariates and was stronger among patients without dementia. Among patients with dementia, there was a weak, nonsignificant effect of delirium on survival. After adjustment for covariates, mortality did not differ between patients with incident and prevalent delirium, but among patients with delirium without dementia, greater severity of delirium symptoms was associated with higher mortality. CONCLUSIONS: Delirium is an independent marker for increased mortality among older medical inpatients during the 12 months after hospital admission. It is a particularly important prognostic marker among patients without dementia.
BACKGROUND:Delirium has not been found to be a significant predictor of postdischarge mortality, but previous research has methodologic limitations including small sample sizes and inadequate control of confounding. This study aimed to determine the independent effects of presence of delirium, type of delirium (incident vs prevalent), and severity of delirium symptoms on 12-month mortality among older medical inpatients. METHODS: A prospective, observational study of 2 cohorts of medical inpatients was conducted with patients 65 years or older: 243 patients had prevalent or incident delirium, and 118 controls had no delirium. Baseline measures included presence of delirium and/or dementia, severity of delirium symptoms, physical function, comorbidity, and physiological and clinical severity of illness. Mortality during the 12 months after enrollment was analyzed with the Cox proportional hazards model with adjustment for covariates. RESULTS: The unadjusted hazard ratio of delirium with mortality was 3.44 (95% confidence interval, 2.05-5.75); the adjusted hazard ratio was 2.11 (95% confidence interval, 1.18-3.77). The effect of delirium was sustained over the entire 12-month period after adjustment for covariates and was stronger among patients without dementia. Among patients with dementia, there was a weak, nonsignificant effect of delirium on survival. After adjustment for covariates, mortality did not differ between patients with incident and prevalent delirium, but among patients with delirium without dementia, greater severity of delirium symptoms was associated with higher mortality. CONCLUSIONS:Delirium is an independent marker for increased mortality among older medical inpatients during the 12 months after hospital admission. It is a particularly important prognostic marker among patients without dementia.
Authors: Jin H Han; Suzanne N Bryce; E Wesley Ely; Sunil Kripalani; Alessandro Morandi; Ayumi Shintani; James C Jackson; Alan B Storrow; Robert S Dittus; John Schnelle Journal: Ann Emerg Med Date: 2011-01-26 Impact factor: 5.721
Authors: Babar A Khan; Anthony J Perkins; Sujuan Gao; Siu L Hui; Noll L Campbell; Mark O Farber; Linda L Chlan; Malaz A Boustani Journal: Crit Care Med Date: 2017-05 Impact factor: 7.598
Authors: Vivek Agarwal; Patrick J O'Neill; Bryan A Cotton; Brenda T Pun; Starre Haney; Jennifer Thompson; Nicholas Kassebaum; Ayumi Shintani; Jeffrey Guy; E Wesley Ely; Pratik Pandharipande Journal: J Burn Care Res Date: 2010 Sep-Oct Impact factor: 1.845
Authors: Dan K Kiely; Edward R Marcantonio; Sharon K Inouye; Michele L Shaffer; Margaret A Bergmann; Frances M Yang; Michael A Fearing; Richard N Jones Journal: J Am Geriatr Soc Date: 2009-01 Impact factor: 5.562
Authors: Stuti J Jaiswal; Thomas J McCarthy; Nathan E Wineinger; Dae Y Kang; Janet Song; Solana Garcia; Christoffel J van Niekerk; Cathy Y Lu; Melissa Loeks; Robert L Owens Journal: Am J Med Date: 2018-05-03 Impact factor: 4.965
Authors: Cynthia J Brown; David L Roth; Richard M Allman; Patricia Sawyer; Christine S Ritchie; Jeffrey M Roseman Journal: Ann Intern Med Date: 2009-03-17 Impact factor: 25.391