姑息治疗患者谵妄的诱发和诱发危险因素

A. Seiler, M. Schubert, C. Hertler, M. Schettle, D. Blum, M. Guckenberger, M. Weller, J. Ernst, R. von Känel, Soenke Boettger
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引用次数: 21

摘要

摘要目的谵妄是姑息治疗患者常见的并发症,尤其是在疾病晚期。迄今为止,关于这一脆弱人群谵妄的危险因素和预后结果的证据仍然很少。方法在一所三级医疗中心进行前瞻性观察队列研究,纳入410例姑息治疗患者。采用简单和多元logistic回归模型来确定易患因素和诱发因素与姑息治疗患者谵妄之间的关系。结果该姑息治疗组谵妄患病率为55.9%,晚期谵妄患病率为93%。谵妄与住院时间延长(p < 0.001)、护理需求增加(p < 0.001)、医疗费用增加(p < 0.001)、住院需求(OR 0.11;可信区间0.069 - -0.171;p < 0.001),死亡率增加(OR 18.29;可信区间8.918 - -37.530;P < 0.001)。谵妄的易感因素为男性(OR 2.19;可信区间1.251 - -3.841;p < 0.01)、虚弱(OR 15.28;可信区间5.885 - -39.665;p < 0.001),听力(OR 3.52;可信区间1.721 - -7.210;p < 0.001),视力障碍(OR 3.15;可信区间1.765 - -5.607;p < 0.001),肿瘤性脑疾病(OR 3.63;可信区间1.033 - -12.771;P < 0.05)。谵妄的诱发因素为急性肾功能衰竭(OR 6.79;可信区间1.062 - -43.405;p < 0.05)和压疮(OR 3.66;可信区间1.102 - -12.149;P < 0.05)。我们的研究确定了姑息治疗患者谵妄的几个易感和诱发危险因素,其中一些因素可以早期针对性地进行修改以减轻症状负担。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Predisposing and precipitating risk factors for delirium in palliative care patients
Abstract Objective Delirium is a common complication in palliative care patients, especially in the terminal phase of the illness. To date, evidence regarding risk factors and prognostic outcomes of delirium in this vulnerable population remains sparse. Method In this prospective observational cohort study at a tertiary care center, 410 palliative care patients were included. Simple and multiple logistic regression models were used to identify associations between predisposing and precipitating factors and delirium in palliative care patients. Results The prevalence of delirium in this palliative care cohort was 55.9% and reached 93% in the terminally ill. Delirium was associated with prolonged hospitalization (p < 0.001), increased care requirements (p < 0.001) and health care costs (p < 0.001), requirement for institutionalization (OR 0.11; CI 0.069–0.171; p < 0.001), and increased mortality (OR 18.29; CI 8.918–37.530; p < 0.001). Predisposing factors for delirium were male gender (OR 2.19; CI 1.251–3.841; p < 0.01), frailty (OR 15.28; CI 5.885–39.665; p < 0.001), hearing (OR 3.52; CI 1.721–7.210; p < 0.001), visual impairment (OR 3.15; CI 1.765–5.607; p < 0.001), and neoplastic brain disease (OR 3.63; CI 1.033–12.771; p < 0.05). Precipitating factors for delirium were acute renal failure (OR 6.79; CI 1.062–43.405; p < 0.05) and pressure sores (OR 3.66; CI 1.102–12.149; p < 0.05). Significance of results Our study identified several predisposing and precipitating risk factors for delirium in palliative care patients, some of which can be targeted early and modified to reduce symptom burden.
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