BACKGROUND: Delirium significantly affects post-operative outcomes, but the incidence, risk factors, and long-term impact of delirium in lung transplant recipients have not been well studied. METHODS: We analyzed 155 lung transplant recipients enrolled in the Lung Transplant Outcomes Group (LTOG) cohort at a single center. We determined delirium incidence by structured chart review, identified risk factors for delirium, determined whether plasma concentrations of 2 cerebral injury markers (neuron-specific enolase [NSE] and glial fibrillary acidic protein [GFAP]) were associated with delirium, and determined the association of post-operative delirium with 1-year survival. RESULTS: Fifty-seven (36.8%) patients developed post-operative delirium. Independent risk factors for delirium included pre-transplant benzodiazepine prescription (relative risk [RR] 1.82; 95% confidence interval [CI] 1.08 to 3.07; p = 0.025), total ischemic time (RR 1.10 per 30-minute increase; 95% CI 1.01 to 1.21; p = 0.027), duration of time with intra-operative mean arterial pressure <60 mm Hg (RR 1.07 per 15-minute increase; 95% CI 1.00 to 1.14; p = 0.041), and Grade 3 primary graft dysfunction (RR 2.13; 95% CI 1.27 to 3.58; p = 0.004). Ninety-one (58.7%) patients had plasma available at 24 hours. Plasma GFAP was inconsistently detected, whereas NSE was universally detectable, with higher NSE concentrations associated with delirium (risk difference 15.1% comparing 75th and 25th percentiles; 95% CI 2.5 to 27.7; p = 0.026). One-year mortality appeared higher among delirious patients, 12.3% compared with 7.1%, but the difference was not significant (p = 0.28). CONCLUSIONS: Post-operative delirium is common in lung transplant recipients, and several potentially modifiable risk factors deserve further study to determine their associated mechanisms and predictive values.
BACKGROUND:Delirium significantly affects post-operative outcomes, but the incidence, risk factors, and long-term impact of delirium in lung transplant recipients have not been well studied. METHODS: We analyzed 155 lung transplant recipients enrolled in the Lung Transplant Outcomes Group (LTOG) cohort at a single center. We determined delirium incidence by structured chart review, identified risk factors for delirium, determined whether plasma concentrations of 2 cerebral injury markers (neuron-specific enolase [NSE] and glial fibrillary acidic protein [GFAP]) were associated with delirium, and determined the association of post-operative delirium with 1-year survival. RESULTS: Fifty-seven (36.8%) patients developed post-operative delirium. Independent risk factors for delirium included pre-transplant benzodiazepine prescription (relative risk [RR] 1.82; 95% confidence interval [CI] 1.08 to 3.07; p = 0.025), total ischemic time (RR 1.10 per 30-minute increase; 95% CI 1.01 to 1.21; p = 0.027), duration of time with intra-operative mean arterial pressure <60 mm Hg (RR 1.07 per 15-minute increase; 95% CI 1.00 to 1.14; p = 0.041), and Grade 3 primary graft dysfunction (RR 2.13; 95% CI 1.27 to 3.58; p = 0.004). Ninety-one (58.7%) patients had plasma available at 24 hours. Plasma GFAP was inconsistently detected, whereas NSE was universally detectable, with higher NSE concentrations associated with delirium (risk difference 15.1% comparing 75th and 25th percentiles; 95% CI 2.5 to 27.7; p = 0.026). One-year mortality appeared higher among delirious patients, 12.3% compared with 7.1%, but the difference was not significant (p = 0.28). CONCLUSIONS: Post-operative delirium is common in lung transplant recipients, and several potentially modifiable risk factors deserve further study to determine their associated mechanisms and predictive values.
Authors: Jane S Saczynski; Edward R Marcantonio; Lien Quach; Tamara G Fong; Alden Gross; Sharon K Inouye; Richard N Jones Journal: N Engl J Med Date: 2012-07-05 Impact factor: 91.245
Authors: Pratik Pandharipande; Bryan A Cotton; Ayumi Shintani; Jennifer Thompson; Brenda Truman Pun; John A Morris; Robert Dittus; E Wesley Ely Journal: J Trauma Date: 2008-07
Authors: Ishaq Lat; Wes McMillian; Scott Taylor; Jeff M Janzen; Stella Papadopoulos; Laura Korth; As'ad Ehtisham; Joe Nold; Suresh Agarwal; Ruben Azocar; Peter Burke Journal: Crit Care Med Date: 2009-06 Impact factor: 7.598
Authors: Jakub Kazmierski; Andrzej Banys; Joanna Latek; Julius Bourke; Ryszard Jaszewski Journal: Int Psychogeriatr Date: 2013-12-17 Impact factor: 3.878
Authors: John A McPherson; Chad E Wagner; Leanne M Boehm; J David Hall; Daniel C Johnson; Leanna R Miller; Kathleen M Burns; Jennifer L Thompson; Ayumi K Shintani; E Wesley Ely; Pratik P Pandharipande; Pratik P Pandhvaripande Journal: Crit Care Med Date: 2013-02 Impact factor: 7.598
Authors: Stuart McGrane; Timothy D Girard; Jennifer L Thompson; Ayumi K Shintani; Alison Woodworth; E Wesley Ely; Pratik P Pandharipande Journal: Crit Care Date: 2011-03-02 Impact factor: 9.097
Authors: Sophia Wang; Ryan Greene; Yiqing Song; Carol Chan; Heidi Lindroth; Sikandar Khan; Gabriel Rios; Robert D Sanders; Babar Khan Journal: Int Psychogeriatr Date: 2022-01-17 Impact factor: 7.191
Authors: Marcelina Czok; Michał P Pluta; Zbigniew Putowski; Łukasz J Krzych Journal: Int J Environ Res Public Health Date: 2021-01-18 Impact factor: 3.390
Authors: Patrick Smith; Jillian C Thompson; Elena Perea; Brian Wasserman; Lauren Bohannon; Alessandro Racioppi; Taewoong Choi; Cristina Gasparetto; Mitchell E Horwitz; Gwynn Long; Richard Lopez; David A Rizzieri; Stefanie Sarantopoulos; Keith M Sullivan; Nelson J Chao; Anthony D Sung Journal: Biol Blood Marrow Transplant Date: 2020-09-19 Impact factor: 5.742