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Delirium symptoms during hospitalization predict long-term mortality in patients with severe pneumonia

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Abstract

Introduction

Delirium is common in critically ill patients and impact in-hospital mortality in patients with pneumonia. The aim of the study was to evaluate the prevalence of delirium symptoms during hospitalization in patients with severe pneumonia and their impact on one-year mortality.

Methods

This was an observational, retrospective, cohort study of consecutive patients admitted to the respiratory high dependency unit of the San Gerardo University Hospital, Monza, Italy, between January 2009 and December 2012 with a diagnosis of severe pneumonia. A search through the charts looking for ten key words associated with delirium (confusion, disorientation, altered mental status, delirium, agitation, inappropriate behavior, mental status change, inattention, hallucination, lethargy) was performed by a multidisciplinary team. The primary endpoint was mortality at one-year follow-up. Secondary endpoint was in-hospital mortality.

Results

A total of 172 patients were enrolled (78 % males; median age 75 years). At least one delirium symptom was detected in 53 patients (31 %) during hospitalization. The prevalence of delirium symptoms was higher among those who died during hospitalization vs. those who survived (44 vs. 27 %, p = 0.049, respectively). Seventy-one patients (46 %) died during the one-year follow-up. The prevalence of at least one delirium symptom was higher among those who died than those who survived during the one-year follow-up (39 vs. 21 %, p = 0.014, respectively). At the multivariable logistic regression analysis, after adjustment for age, comorbidities and severe sepsis, the presence of at least one delirium symptom during hospitalization was an independent predictor of one-year mortality (OR 2.35; 95 % CI 1.13–4.90; p = 0.023).

Conclusions

Delirium symptoms are independent predictors of one-year mortality in hospitalized patients with severe pneumonia. Further studies should confirm our results using prospective methods of collecting data.

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Abbreviations

ATS:

American Thoracic Society

CAM:

Confusion assessment method

CCI:

Charlson comorbidity index

CXR:

Chest radiograph

DSM:

Diagnostic and statistical manual of mental disorders

FiO2 :

Inspiratory fraction of oxygen

ICU:

Intensive care unit

IDSA:

Infectious Disease Society of America

IQR:

Interquartile range

LOS:

Length of stay in the hospital

OR:

Odds ratio

PaCO2 :

Partial pressure of carbon dioxide in the arterial blood

PaO2 :

Partial pressure of oxygen in the arterial blood

RHDU:

Respiratory high dependency unit

References

  1. American Psychiatric Association (2013) ed DSM-5-TM, Diagnostic and statistical manual of mental disorders. 5th ed. American Psychiatric Association, Washington

  2. Ely EW, Margolin R, Francis J, May L, Truman B, Dittus R, Speroff T, Gautam S, Bernard GR, Inouye SK (2001) Evaluation of delirium in critically ill patients: validation of the Confusion Assessment Method for the Intensive Care Unit (CAMICU). Crit Care Med 29:1370–1379

    Article  CAS  PubMed  Google Scholar 

  3. Zhang Z, Pan L, Ni H (2013) Impact of delirium on clinical outcome in critically ill patients: a meta-analysis. Gen Hosp Psychiatry 35:105–111

    Article  CAS  PubMed  Google Scholar 

  4. Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, Dowell SF, File TM Jr, Musher DM, Niederman MS, Torres A, Whitney CG, Infectious Diseases Society of America, American Thoracic Society (2007) Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 44:S27–S72

    Article  CAS  PubMed  Google Scholar 

  5. Pieralli F, Vannucchi V, Mancini A, Grazzini M, Paolacci G, Morettini A, Nozzoli C (2014) Delirium is a predictor of in-hospital mortality in elderly patients with community acquired pneumonia. Intern Emerg Med 9:195–200

    Article  PubMed  Google Scholar 

  6. Waterer GW, Kessler LA, Wunderink RG (2004) Medium-term survival after hospitalization with community-acquired pneumonia. Am J Respir Crit Care Med 169:910–914

    Article  PubMed  Google Scholar 

  7. Yende S, D’Angelo G, Kellum JA, Weissfeld L, Fine J, Welch RD, Kong L, Carter M, Angus DC, GenIMS Investigators (2008) Inflammatory markers at hospital discharge predict subsequent mortality after pneumonia and sepsis. Am J Respir Crit Care Med 177:1242–1247

    Article  PubMed Central  PubMed  Google Scholar 

  8. Capelastegui A, España PP, Quintana JM, Bilbao A, Menendez R, Zalacain R, Torres A (2009) Development of a prognostic index for 90-day mortality in patients discharged after admission to hospital for community-acquired pneumonia. Thorax 64:496–501

    Article  CAS  PubMed  Google Scholar 

  9. Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383

    Article  CAS  PubMed  Google Scholar 

  10. Corrado A, Roussos C, Ambrosino N, Confalonieri M, Cuvelier A, Elliott M, Ferrer M, Gorini M, Gurkan O, Muir JF, Quareni L, Robert D, Rodenstein D, Rossi A, Schoenhofer B, Simonds AK, Strom K, Torres A, Zakynthinos S, European Respiratory Society Task Force on epidemiology of respiratory intermediate care in Europe (2002) Respiratory intermediate care units: a European survey. Eur Respir J 20:1343–1350

    Article  CAS  PubMed  Google Scholar 

  11. Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, Sevransky JE, Sprung CL, Douglas IS, Jaeschke R, Osborn TM, Nunnally ME, Townsend SR, Reinhart K, Kleinpell RM, Angus DC, Deutschman CS, Machado FR, Rubenfeld GD, Webb S, Beale RJ, Vincent JL, Moreno R, Surviving Sepsis Campaign Guidelines Committee including The Pediatric Subgroup (2013) Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med 39:165–228

    Article  CAS  PubMed  Google Scholar 

  12. Woodhead M, Blasi F, Ewig S, Garau J, Huchon G, Ieven M, Ortqvist A, Schaberg T, Torres A, van der Heijden G, Read R, Verheij TJ, Joint Taskforce of the European Respiratory Society and European Society for Clinical Microbiology and Infectious Diseases (2011) Guidelines for the management of adult lower respiratory tract infections—full version. Clin Microbiol Infect 17(Suppl 6):E1–E59

    Article  PubMed  Google Scholar 

  13. American Thoracic Society, Infectious Diseases Society of America (2005) Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med 171:388–416

    Article  Google Scholar 

  14. Inouye SK, Leo-Summers L, Zhang Y, Bogardus ST Jr, Leslie DL, Agostini JV (2005) A chart-based method for identification of delirium: validation compared with interviewer ratings using the confusion assessment method. J Am Geriatr Soc 53:312–318

    Article  PubMed  Google Scholar 

  15. Morandi A, Solberg LM, Habermann R, Cleeton P, Peterson E, Ely EW, Schnelle J (2009) Documentation and management of words associated with delirium among elderly patients in postacute care: a pilot investigation. J Am Med Dir Assoc 10:330–334

    Article  PubMed  Google Scholar 

  16. Bellelli G, Mazzola P, Corsi M, Zambon A, Corrao G, Castoldi G, Zatti G, Annoni G (2012) The combined effect of ADL impairment and delay in time from fracture to surgery on 12-month mortality: an observational study in orthogeriatric patients. J Am Med Dir Assoc 13:e9–e14

    PubMed  Google Scholar 

  17. Cole MG (2004) Delirium in elderly patients. Am J Geriatr Psychiatry 12:7–21

    Article  PubMed  Google Scholar 

  18. Thomason JW, Shintani A, Peterson JF, Pun BT, Jackson JC, Ely EW (2005) Intensive care unit delirium is an independent predictor of longer hospital stay: a prospective analysis of 261 non-ventilated patients. Crit Care 9:R375–R381

    Article  PubMed Central  PubMed  Google Scholar 

  19. Pisani MA, Kong SY, Kasl SV, Murphy TE, Araujo KL, Van Ness PH (2009) Days of delirium are associated with 1-year mortality in an older intensive care unit population. Am J Respir Crit Care Med 180:1092–1097

    Article  PubMed Central  PubMed  Google Scholar 

  20. Eeles EM, White SV, O’Mahony SM, Bayer AJ (2012) Hubbard RE (2012) The impact of frailty and delirium on mortality in older inpatients. Age Ageing 41:412–416

    Article  PubMed  Google Scholar 

  21. Maclullich AM, Ferguson KJ, Miller T, de Rooij SE, Cunningham C (2008) Unravelling the pathophysiology of delirium: a focus on the role of aberrant stress responses. J Psychosom Res 65:229–238

    Article  PubMed Central  PubMed  Google Scholar 

  22. van Gool WA, van de Beek D, Eikelenboom P (2010) Systemic infection and delirium: when cytokines and acetylcholine collide. Lancet 375:773–775

    Article  PubMed  Google Scholar 

  23. Lim WS, van der Eerden MM, Laing R, Boersma WG, Karalus N, Town GI, Lewis SA, Macfarlane JT (2003) Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax 58:377–382

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  24. Fine MJ, Auble TE, Yealy DM, Hanusa BH, Weissfeld LA, Singer DE, Coley CM, Marrie TJ, Kapoor WN (1997) A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med 336:243–250

    Article  CAS  PubMed  Google Scholar 

  25. Kiely DK, Jones RN, Bergmann MA, Murphy KM, Orav EJ, Marcantonio ER (2006) Association between delirium resolution and functional recovery among newly admitted postacute facility patients. J Gerontol A Biol Sci Med Sci 61:204–208

    Article  PubMed  Google Scholar 

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Conflict of interest

The authors declare that they have no competing interests.

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Authors and Affiliations

  1. Department of Health Science, Clinica Pneumologica, AO San Gerardo, University of Milan Bicocca, Via Pergolesi 33, Monza, Italy

    Stefano Aliberti, Mauro Belotti, Grazia Messinesi & Alberto Pesci

  2. Rehabilitation and Aged Care Unit Hospital Ancelle, Cremona, Italy

    Alessandro Morandi

  3. Geriatric Research Group, Brescia, Italy

    Alessandro Morandi

  4. Department of Health Science, Clinica Geriatrica, AO San Gerardo, University of Milan Bicocca, Via Pergolesi 33, Monza, Italy

    Giuseppe Bellelli & Giorgio Annoni

Authors
  1. Stefano Aliberti
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  2. Giuseppe Bellelli
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  3. Mauro Belotti
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  4. Alessandro Morandi
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  5. Grazia Messinesi
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  6. Giorgio Annoni
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  7. Alberto Pesci
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Correspondence to Stefano Aliberti.

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Aliberti, S., Bellelli, G., Belotti, M. et al. Delirium symptoms during hospitalization predict long-term mortality in patients with severe pneumonia. Aging Clin Exp Res 27, 523–531 (2015). https://doi.org/10.1007/s40520-014-0297-9

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  • DOI: https://doi.org/10.1007/s40520-014-0297-9

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