移植后谵妄的临床和神经影像学相关性

IF 4.3 Q1 Medicine
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
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引用次数: 0

摘要

谵妄在接受造血干细胞移植(HCT)的成年人中很常见,尽管HCT后谵妄的临床和神经影像学相关因素尚未得到充分的描述。因此,我们对115名接受同种异体HCT后神经影像学检查的成年人进行回顾性队列研究,检查了移植后谵妄的频率和神经影像学相关因素。谵妄是使用先前验证的方法来回顾性鉴定经图表评估的术后谵妄。2009年1月至2016年12月,一个具有HCT、精神病学和心理学专业知识的多学科团队对在同一中心连续接受神经影像学评估和移植的同种异体HCT患者进行了独立的图表审查。同时记录脑白质损伤和脑容量损失的神经影像学指标。共纳入115例患者,年龄20 ~ 74岁(平均[SD]年龄49岁[13])。53例患者(46%)出现hct后谵妄。在一个调整后的模型中,谵妄的发病率与年龄较大(比值比[OR],每十年1.92 [1.28,2.87],P = 0.002)、白质高信号的严重程度(OR, 1.95 [1.06, 3.57], P = 0.031)和调节强度(OR, 6.37 [2.20, 18.45], P <.001),但与皮质萎缩无关(P = .777)。谵妄与较少的无院天数相关(P = 0.023),但与总生存率无关(风险比,0.95 [0.56,1.61],P = 0.844)。HCT后谵妄的高发生率与较大的年龄、微血管负荷和调节强度相关。hct前考虑微血管负荷和其他神经成像生物标志物的风险可能是有必要的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Clinical and Neuroimaging Correlates of Post-Transplant Delirium

Delirium is common among adults undergoing hematopoietic stem cell transplantation (HCT), although the clinical and neuroimaging correlates of post-HCT delirium have not been adequately delineated. We therefore examined the frequency of delirium and neuroimaging correlates of post-transplant delirium in a retrospective cohort of 115 adults undergoing neuroimaging after allogeneic HCT. Delirium was established using previously validated methods for retrospective identification of chart-assessed postprocedural delirium. Chart reviews were independently conducted by a multidisciplinary team with expertise in HCT, psychiatry, and psychology on consecutive allogeneic HCT patients who underwent neuroimaging assessments and transplantation at a single center between January 2009 and December 2016. Neuroimaging markers of white matter damage and brain volume loss were also recorded. In total, 115 patients were included, ranging in age from 20 to 74 years (mean [SD] age, 49 [13]). Fifty-three patients (46%) developed post-HCT delirium. In an adjusted model, delirium incidence was associated with older age (odds ratio [OR], 1.92 [1.28, 2.87] per decade, P = .002), greater severity of white matter hyperintensities (OR, 1.95 [1.06, 3.57], P = .031), and conditioning intensity (OR, 6.37 [2.20, 18.45], P < .001) but was unrelated to cortical atrophy (P = .777). Delirium was associated with fewer hospital-free days (P = .023) but was not associated with overall survival (hazard ratio, 0.95 [0.56, 1.61], P = .844). Greater incidence of delirium following HCT was associated with greater age, microvascular burden, and conditioning intensity. Pre-HCT consideration of microvascular burden and other neuroimaging biomarkers of risk may be warranted.

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来源期刊
CiteScore
6.60
自引率
0.00%
发文量
1061
审稿时长
3-6 weeks
期刊介绍: Biology of Blood and Marrow Transplantation publishes original research reports, reviews, editorials, commentaries, letters to the editor, and hypotheses and is the official publication of the American Society for Transplantation and Cellular Therapy. The journal focuses on current technology and knowledge in the interdisciplinary field of hematopoetic stem cell transplantation.
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