原有严重精神疾病患者的谵妄风险和死亡率:利用英格兰相关数据集进行的回顾性队列研究。

IF 5.9 2区 医学 Q1 PSYCHIATRY
Yehudit Bauernfreund, Naomi Launders, Graziella Favarato, Joseph F Hayes, David Osborn, Elizabeth L Sampson
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引用次数: 0

摘要

背景:谵妄是一种由躯体疾病引起的严重神经精神综合征,死亡率很高。了解谵妄的风险因素是有针对性地进行预防和筛查的关键。重性精神病(SMI)是否会导致谵妄,目前尚不清楚。我们的目的是确定已有的 SMI 诊断是否与较高的谵妄诊断风险和谵妄诊断后的死亡率有关:一项回顾性队列和嵌套病例对照研究,使用的是 2000-2017 年间相互关联的初级和中级医疗保健数据库。我们确定了被诊断为 SMI 的患者,并与非 SMI 的比较者进行了匹配。我们比较了被诊断为 SMI 患者和参照者之间以及 SMI 亚型(精神分裂症、双相情感障碍和 "其他精神病")之间的谵妄诊断发生率。我们比较了被诊断为 SMI 的患者与参照者之间以及不同 SMI 亚型之间因谵妄住院后 30 天的死亡率:我们确定了 20 566 名被诊断为 SMI 的患者,并与 71 374 名参照者进行了匹配。所有 SMI 亚型的谵妄诊断风险都较高,65 岁以下组的 SMI 风险更高(aHR:7.65, 95% CI 5.45-10.7;⩾65 岁组:aHR:3.35, 95% CI 2.77-4.05)。与没有SMI的人相比,诊断出SMI的人在谵妄住院后30天的死亡率总体上没有差异(OR:0.66,95% CI 0.38-1.14):我们发现 SMI 与谵妄诊断之间存在关联。结论:我们发现 SMI 与谵妄诊断之间存在关联,与非 SMI 患者相比,SMI 患者在住院期间更容易出现谵妄。电子医疗记录的使用存在局限性,需要进一步的前瞻性研究来证实这些发现。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Delirium risk and mortality in people with pre-existing severe mental illness: a retrospective cohort study using linked datasets in England.

Background: Delirium is a severe neuropsychiatric syndrome caused by physical illness, associated with high mortality. Understanding risk factors for delirium is key to targeting prevention and screening. Whether severe mental illness (SMI) predisposes people to delirium is not known. We aimed to establish whether pre-existing SMI diagnosis is associated with higher risk of delirium diagnosis and mortality following delirium diagnosis.

Methods: A retrospective cohort and nested case-control study using linked primary and secondary healthcare databases from 2000-2017. We identified people diagnosed with SMI, matched to non-SMI comparators. We compared incidence of delirium diagnoses between people with SMI diagnoses and comparators, and between SMI subtypes; schizophrenia, bipolar disorder and 'other psychosis'. We compared 30-day mortality following a hospitalisation involving delirium between people with SMI diagnoses and comparators, and between SMI subtypes.

Results: We identified 20 566 people with SMI diagnoses, matched to 71 374 comparators. Risk of delirium diagnosis was higher for all SMI subtypes, with a higher risk conferred by SMI in the under 65-year group, (aHR:7.65, 95% CI 5.45-10.7, ⩾65-year group: aHR:3.35, 95% CI 2.77-4.05). Compared to people without SMI, people with an SMI diagnosis overall had no difference in 30-day mortality following a hospitalisation involving delirium (OR:0.66, 95% CI 0.38-1.14).

Conclusions: We found an association between SMI and delirium diagnoses. People with SMI may be more vulnerable to delirium when in hospital than people without SMI. There are limitations to using electronic healthcare records and further prospective study is needed to confirm these findings.

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来源期刊
Psychological Medicine
Psychological Medicine 医学-精神病学
CiteScore
11.30
自引率
4.30%
发文量
711
审稿时长
3-6 weeks
期刊介绍: Now in its fifth decade of publication, Psychological Medicine is a leading international journal in the fields of psychiatry, related aspects of psychology and basic sciences. From 2014, there are 16 issues a year, each featuring original articles reporting key research being undertaken worldwide, together with shorter editorials by distinguished scholars and an important book review section. The journal''s success is clearly demonstrated by a consistently high impact factor.
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