Long-term outcome of delirium during intensive care unit stay in survivors of critical illness: a prospective cohort study

Annemiek E Wolters, Diederik van Dijk, Wietze Pasma, Olaf L Cremer, Marjolein F Looije, Dylan W de Lange, Dieuwke S Veldhuijzen, Arjen J C Slooter, Annemiek E Wolters, Diederik van Dijk, Wietze Pasma, Olaf L Cremer, Marjolein F Looije, Dylan W de Lange, Dieuwke S Veldhuijzen, Arjen J C Slooter

Abstract

Introduction: Delirium is associated with impaired outcome, but it is unclear whether this relationship is limited to in-hospital outcomes and whether this relationship is independent of the severity of underlying conditions. The aim of this study was to investigate the association between delirium in the intensive care unit (ICU) and long-term mortality, self-reported health-related quality of life (HRQoL), and self-reported problems with cognitive functioning in survivors of critical illness, taking severity of illness at baseline and throughout ICU stay into account.

Methods: A prospective cohort study was conducted. We included patients who survived an ICU stay of at least a day; exclusions were neurocritical care patients and patients who sustained deep sedation during the entire ICU stay. Delirium was assessed twice daily with the Confusion Assessment Method for the ICU (CAM-ICU) and additionally, patients who received haloperidol were considered delirious. Twelve months after ICU admission, data on mortality were obtained and HRQoL and cognitive functioning were measured with the European Quality of Life - Six dimensions self-classifier (EQ-6D). Regression analyses were used to assess the associations between delirium and the outcome measures adjusted for gender, type of admission, the Acute Physiology And Chronic Health Evaluation IV (APACHE IV) score, and the cumulative Sequential Organ Failure Assessment (SOFA) score throughout ICU stay.

Results: Of 1101 survivors of critical illness, 412 persons (37%) had been delirious during ICU stay, and 198 (18%) died within twelve months. When correcting for confounders, no significant association between delirium and long-term mortality was found (hazard ratio: 1.26; 95% confidence interval (CI) 0.93 to 1.71). In multivariable analysis, delirium was not associated with HRQoL either (regression coefficient: -0.04; 95% CI -0.10 to 0.01). Yet, delirium remained associated with mild and severe problems with cognitive functioning in multivariable analysis (odds ratios: 2.41; 95% CI 1.57 to 3.69 and 3.10; 95% CI 1.10 to 8.74, respectively).

Conclusions: In this group of survivors of critical illness, delirium during ICU stay was not associated with long-term mortality or HRQoL after adjusting for confounding, including severity of illness throughout ICU stay. In contrast, delirium appears to be an independent risk factor for long-term self-reported problems with cognitive functioning.

Figures

Figure 1
Figure 1
Study flow chart. ICU: Intensive Care Unit; RASS: Richmond Agitation Sedation Scale; SOFA: Sequential Organ Failure Assessment.

References

    1. Wolters AE, Slooter AJC, van der Kooi AW, van Dijk D. Cognitive impairment after intensive care unit admission: a systematic review. Intensive Care Med. 2013;39:376–386.
    1. Davydow DS, Hough CL, Langa KM, Iwashyna TJ. Pre-sepsis depressive symptoms are associated with incident cognitive impairment in survivors of severe sepsis: a prospective cohort study of older Americans. J Am Geriatr Soc. 2012;60:2290–2296.
    1. Iwashyna TJ, Ely EW, Smith DM, Langa KM. Long-term cognitive impairment and functional disability among survivors of severe sepsis. JAMA. 2010;304:1787–1794.
    1. Herridge MS, Tansey CM, Matté A, Tomlinson G, Diaz-Granados N, Cooper A, Guest CB, Mazer CD, Mehta S, Stewart TE, Kudlow P, Cook D, Slutsky AS, Cheung AM. Functional disability 5 years after acute respiratory distress syndrome. N Engl J Med. 2011;364:1293–1304.
    1. Bienvenu OJ, Colantuoni E, Mendez-Tellez PA, Dinglas VD, Shanholtz C, Husain N, Dennison CR, Herridge MS, Pronovost PJ, Needham DM. Depressive symptoms and impaired physical function after acute lung injury. Am J Respir Crit Care Med. 2012;185:517–524.
    1. American Psychiatry Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) 4 Revision. Washington, DC: American Psychiatric Association; 2000. pp. 135–147.
    1. Van Eijk MM, van den Boogaard M, van Marum RJ, Benner P, Eikelenboom P, Honing ML, van der Hoven B, Horn J, Izaks GJ, Kalf A, Karakus A, Klijn IA, Kuiper MA, de Leeuw FE, de Man T, van der Mast RC, Osse RJ, de Rooij SE, Spronk PE, van der Voort PH, van Gool WA, Slooter AJ. Routine use of the confusion assessment method for the intensive care unit: a multicenter study. Am J Respir Crit Care Med. 2011;184:340–344.
    1. Pandharipande P, Cotton BA, Shintan A, Thompson J, Truman B, Morris JA, Dittus R, Ely EW. Prevalence and risk factors for development of delirium in surgical and trauma ICU patients. J Trauma. 2008;65:34–41.
    1. Girard TD, Jackson JC, Pandharipande PP, Pun BT, Thompson JL, Shintani AK, Gordon SM, Canonico AE, Dittus RS, Bernard GR, Ely EW. Delirium as a predictor of long-term cognitive impairment in survivors of critical illness. Crit Care Med. 2010;38:1513–1520.
    1. Pandharipande PP, Girard TD, Jackson JC, Morandi A, Thompson JL, Pun BT, Brummel NE, Hughes CG, Vasilevskis EE, Shintani AK, Moons KG, Geevarghese SK, Canonico AE, Hopkins RO, Bernard GR, Dittus RS, Ely EW. Long-term cognitive impairment after critical illness. N Engl J Med. 2013;369:1306–1316.
    1. Van den Boogaard M, Schoonhoven L, Evers AW, van der Hoeven JG, van Achterberg T, Pickkers P. Delirium in critically ill patients: impact on long-term health-related quality of life and cognitive functioning. Crit Care Med. 2012;40:112–118.
    1. Van Rompaey B, Schuurmans MJ, Shortridge-Baggett LM, Truijen S, Elseviers M, Bossaert L. Long term outcome after delirium in the intensive care unit. J Clin Nurs. 2009;18:3349–3357.
    1. Ely EW, Shintani A, Truman B, Speroff T, Gordon SM, Harrell FE, Inouye SK, Bernard GR, Dittus RS. Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA. 2004;291:1753–1762.
    1. Abelha FJ, Luís C, Veiga D, Parente D, Fernandes V, Santos P, Botelho M, Santos A, Santos C. Outcome and quality of life in patients with postoperative delirium during an ICU stay following major surgery. Crit Care. 2013;17:R257.
    1. Gusi N, Olivares PR, Rajendram R. Handbook of Disease Burdens and Quality of Life Measures. New York: Springer; 2010. The EQ-5D Health-Related Quality of Life Questionnaire; pp. 87–99.
    1. Svenningsen H, Tønnesen EK, Videbech P, Frydenberg M, Christensen D, Egerod I. Intensive care delirium - effect on memories and health-related quality of life - a follow-up study. J Clin Nurs. 2013;23:634–644.
    1. Slooter AJ. Neurocritical care: critical illness, delirium and cognitive impairment. Nat Rev Neurol. 2013;9:666–667.
    1. Lone NI, Walsh TS. Impact of intensive care unit organ failures on mortality during the five years after a critical illness. Am J Respir Crit Care Med. 2012;186:640–647.
    1. Ely EW, Margolin R, Francis J, May L, Truman B, Dittus R, Speroff T, Gautam S, Bernard GR, Inouye SK. Evaluation of delirium in critically ill patients: validation of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) Crit Care Med. 2001;29:1370–1379.
    1. Zaal IJ, Spruyt CF, Peelen LM, van Eijk MM, Wientjes R, Schneider MM, Kesecioglu J, Slooter AJ. Intensive care unit environment may affect the course of delirium. Intensive Care Med. 2013;39:481–488.
    1. Hoeymans N, Sprangers MA. Kwaliteit van leven gemeten met de EQ-6D. [The gateway to information about public health and healthcare.] [ ]
    1. Lamers LM, Mcdonnell J, Stalmeier PF, Krabbe PF, Busschbach JJV. The Dutch tariff: results and arguments for an effective design for national EQ-5D valuation studies. Health Econ. 2006;15:1121–1132.
    1. Szende A, Oppe M, Devlin N. EQ-5D value sets; inventory, comparative review and user guide. Dordrecht: Springer; 2007.
    1. Stolk E, Krabbe P, Busschbach J. Proceedings of the 24th Scientific Plenary Meeting of the EuroQoL Group. Kijkduin – The Hague: EuroQol Group; 2009. Using the Internet to collect EQ-5D norm scores: a valid alternative; pp. 153–156.
    1. Patel SB, Poston JT, Pohlman A, Hall JB, Kress JP. Rapidly reversible, sedation-related delirium versus persistent delirium in the intensive care unit. Am J Respir Crit Care Med. 2014;189:658–665.
    1. Van den Boogaard M, Pickkers P, Slooter AJ, Kuiper MA, Spronk PE, van der Voort PH, van der Hoeven JG, Donders R, van Achterberg T, Schoonhoven L. Development and validation of PRE-DELIRIC ( PREdiction of DELIRium in ICu patients ) delirium prediction model for intensive care patients: observational multicentre study. BMJ. 2012;344:e420.

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