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Cai X, Shi J, Xu Y, Fu L, Feng X, Zhao R. An important diagnostic marker of acute myocardial infarction patients: Plasma miRNA133 levels. Medicine (Baltimore) 2024; 103:e38781. [PMID: 39029016 PMCID: PMC11398832 DOI: 10.1097/md.0000000000038781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/21/2024] Open
Abstract
The objective of this study was to explore changes in miRNA133 levels as a basis for clinical diagnostic markers in patients with acute myocardial infarction (AMI). A total of 100 chest pain patient cases admitted to a hospital from June 2021 to December 2022 were used. The study involved the selection of 50 patients: 25 patients with unstable undetermined heart pain and 25 healthy subjects were included in the control group of 50 patients with non-AMI patients. Meanwhile, 50 patients with AMI were designated as the experimental group. Changes in miRNA133 levels in patients' plasma were analyzed for expression using quantitative fluorescence analysis. When the serum TPI, plasma NT-ProBNP, glycosylated hemoglobin, and plasma D-dimer index values were compared between the control and experimental groups, there was a statistically significant difference (P < .05). mi-RNA-133 had a mean plasma level value of 2.60 ± 1.01, the mean level value of mi-RNA-133 in patients with non-AMI was 1.34 ± 1.18, and the patients in the AMI group showed significantly high values of the mean plasma level of mi-RNA-133. The relative expression level value of cTnl in patients with AMI was 10.84 ± 12.64. Of the specificity and sensitivity diagnostics, mi-RNA-133 had the best diagnostic effect. The area under mi-RNA-133 in the regression curve was 95.4%, the specificity of the whole combination of indicators was 89.4% and the sensitivity was 100%. Finally, the correlation between mi-RNA-133 and white blood cell count (WBC) and TG was statistically significant (P < .05). In conclusion, changes in the level of mi-RNA-133 may be an important marker for diagnosing the status of patients with AMI, while a faster and more accurate method will emerge along with the improvement of the detection technology, and at the same time, due to the variability of the study cases and other limitations, further research will be carried out subsequently.
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Affiliation(s)
- Xiaona Cai
- Department of Cardiology, Shaoxing People's Hospital, Shaoxing, Zhejiang, China
| | - Jialin Shi
- School of Medicine, ShaoXing University, Shaoxing, Zhejiang, China
| | - Yangmiao Xu
- Department of Cardiology, Shaoxing People's Hospital, Shaoxing, Zhejiang, China
| | - Liying Fu
- Department of Cardiology, Shaoxing People's Hospital, Shaoxing, Zhejiang, China
| | - Xiuming Feng
- Department of Cardiology, Shaoxing People's Hospital, Shaoxing, Zhejiang, China
| | - Ruifang Zhao
- Department of Cardiology, Shaoxing People's Hospital, Shaoxing, Zhejiang, China
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2
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Tan JF, Duan L, Han JC, Cui JJ. Clinical characteristics of delirium in older patients with first-ever acute myocardial infarction who underwent percutaneous coronary intervention : A retrospective study. Herz 2024:10.1007/s00059-024-05250-5. [PMID: 38829438 DOI: 10.1007/s00059-024-05250-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 04/05/2024] [Accepted: 04/25/2024] [Indexed: 06/05/2024]
Abstract
OBJECTIVES Delirium is a serious complication of cardiac surgery and a common clinical problem. The study aimed to identify the incidence, risk factors, and outcomes of delirium in older patients (≥ 65 years) with first-ever acute myocardial infarction (AMI) who underwent percutaneous coronary intervention (PCI). METHODS A retrospective cohort study was performed in a hospital in northern China. A total of 1033 older patients with first-ever AMI who underwent PCI between January 2018 and April 2021 were screened for delirium using the CAM-ICU method. Clinical and laboratory data were collected. RESULTS A total of 134 (12.97%) patients were diagnosed with delirium. Patients with delirium were older. The most common concomitant diseases were cardiac arrest, chronic renal failure, and a history of coronary artery bypass graft (CABG). Delirious patients experienced more times of mechanical ventilation, more intra-aortic balloon pump (IABP) support, high postoperative immediate pain score (VAS), more non-bedside cardiac rehabilitation, and longer total length of stay and cardiac care unit (CCU) time. Multivariable logistic regression showed that age, mechanical ventilation, postoperative immediate pain score, and non-bedside cardiac rehabilitation were independently associated with delirium. Delirium was an independent predictor of prolonged CCU stay, total length of stay, and 1‑year mortality. CONCLUSION Age, mechanical ventilation, postoperative immediate pain score, and non-bedside cardiac rehabilitation were independently closely related to delirium in older patients with first-ever AMI who underwent PCI. Delirium was associated with a higher 1‑year all-cause mortality.
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Affiliation(s)
- Jin-Feng Tan
- Department of Cardiology, the Second Affiliated Hospital of Harbin Medical University, No.246, Xuefu Road, Harbin, Heilongjiang Province, China
| | - Le Duan
- Department of Anesthesiology, the Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jin-Cheng Han
- Department of Cardiology, the Second Affiliated Hospital of Harbin Medical University, No.246, Xuefu Road, Harbin, Heilongjiang Province, China
| | - Jin-Jin Cui
- Department of Cardiology, the Second Affiliated Hospital of Harbin Medical University, No.246, Xuefu Road, Harbin, Heilongjiang Province, China.
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3
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Dimitriadou I, Fradelos EC, Skoularigis J, Toska A, Vogiatzis I, Papagiannis D, Saridi M. The impact of delirium on clinical and functional outcomes in hospitalized patients with acute coronary syndrome. Nurs Crit Care 2024. [PMID: 38602059 DOI: 10.1111/nicc.13079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 03/14/2024] [Accepted: 04/02/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND Delirium, which is prevalent in critical care settings, remains underexplored in acute coronary syndrome (ACS) patients in the cardiac intensive care unit (CICU). AIMS To investigate the prevalence and clinical significance of delirium in patients with ACS admitted to the CICU. STUDY DESIGN A prospective study (n = 106, mean age 74.2 ± 5.7 years) assessed delirium using the confusion assessment method-intensive care unit (CAM-ICU) tool in 21.7% of ACS patients during their CICU stay. Baseline characteristics, geriatric conditions and clinical procedures were compared between delirious and nondelirious patients. The outcomes included in-hospital mortality, 30-day and 6-month mortality, acute adverse events and length of CICU stay and hospital stay (LOS). RESULTS Delirious patients who were older and had a higher incidence of coronary artery disease underwent more complex procedures (e.g., pacemaker placement). Multivariate analysis identified central venous catheter insertion, urinary catheterization and benzodiazepine use as independent predictors of delirium. Delirium was correlated with prolonged LOS (p < .001) and increased in-hospital, 30-day and 6-month mortality (p < .001). CONCLUSIONS Delirium in ACS patients in the CICU extends hospitalization and increases in-hospital, 30-day and 6-month mortality. Early recognition and targeted interventions are crucial for mitigating adverse outcomes in this high-risk population. RELEVANCE TO CLINICAL PRACTICE This study highlights the critical impact of delirium on outcomes in hospitalized patients with ACS in the CICU. Delirium, often overlooked in ACS management, significantly extends hospitalization and increases mortality rates. Nurses and physicians must be vigilant in identifying delirium early, particularly in older ACS patients or those with comorbidities. Recognizing independent predictors such as catheterization and benzodiazepine use allows for targeted interventions to reduce delirium incidence. Integrating routine delirium assessments and preventive strategies into ACS management protocols can improve outcomes, optimize resource utilization and enhance overall patient care in the CICU setting.
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Affiliation(s)
- Ioanna Dimitriadou
- Laboratory of Clinical Nursing, Department of Nursing, University of Thessaly, Larissa, Greece
| | - Evangelos C Fradelos
- Laboratory of Clinical Nursing, Department of Nursing, University of Thessaly, Larissa, Greece
| | - John Skoularigis
- Cardiology Department, General University Hospital of Larissa, Larissa, Greece
| | - Aikaterini Toska
- Laboratory of Clinical Nursing, Department of Nursing, University of Thessaly, Larissa, Greece
| | | | - Dimitrios Papagiannis
- Laboratory of Clinical Nursing, Department of Nursing, University of Thessaly, Larissa, Greece
| | - Maria Saridi
- Laboratory of Clinical Nursing, Department of Nursing, University of Thessaly, Larissa, Greece
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Alonso Salinas GL, Cepas-Guillén P, León AM, Jiménez-Méndez C, Lozano-Vicario L, Martínez-Avial M, Díez-Villanueva P. The Impact of Geriatric Conditions in Elderly Patients with Coronary Heart Disease: A State-of-the-Art Review. J Clin Med 2024; 13:1891. [PMID: 38610656 PMCID: PMC11012545 DOI: 10.3390/jcm13071891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 03/18/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
The growing geriatric population presenting with coronary artery disease poses a primary challenge for healthcare services. This is a highly heterogeneous population, often underrepresented in studies and clinical trials, with distinctive characteristics that render them particularly vulnerable to standard management/approaches. In this review, we aim to summarize the available evidence on the treatment of acute coronary syndrome in the elderly. Additionally, we contextualize frailty, comorbidity, sarcopenia, and cognitive impairment, common in these patients, within the realm of coronary artery disease, proposing strategies for each case that may assist in therapeutic approaches.
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Affiliation(s)
- Gonzalo Luis Alonso Salinas
- Cardiology Department, Hospital Universitario de Navarra (HUN-NOU), Calle de Irunlarrea, 3, 31008 Pamplona, Spain;
- Navarrabiomed (Miguel Servet Foundation), IdiSNA, 31008 Pamplona, Spain;
- Heath Sciences Department, Universidad Pública de Navarra (UPNA-NUP), 31006 Pamplona, Spain
| | - Pedro Cepas-Guillén
- Quebec Heart and Lung Institute, Laval University, 2725 Ch Ste-Foy, Quebec, QC G1V 4G5, Canada;
| | - Amaia Martínez León
- Cardiology Department, Hospital Universitario de Navarra (HUN-NOU), Calle de Irunlarrea, 3, 31008 Pamplona, Spain;
- Navarrabiomed (Miguel Servet Foundation), IdiSNA, 31008 Pamplona, Spain;
| | - César Jiménez-Méndez
- Cardiology Department, Hospital Universitario Puerta del Mar, Avda Ana de Viya 21, 11009 Cádiz, Spain;
| | - Lucia Lozano-Vicario
- Navarrabiomed (Miguel Servet Foundation), IdiSNA, 31008 Pamplona, Spain;
- Geriatric Medicine Department, Hospital Universitario de Navarra (HUN-NOU), Calle de Irunlarrea, 3, 31008 Pamplona, Spain
| | - María Martínez-Avial
- Cardiology Department, Hospital Universitario La Princesa, Calle Diego de León 62, 28006 Madrid, Spain; (M.M.-A.); (P.D.-V.)
| | - Pablo Díez-Villanueva
- Cardiology Department, Hospital Universitario La Princesa, Calle Diego de León 62, 28006 Madrid, Spain; (M.M.-A.); (P.D.-V.)
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Park DY, Jamil Y, Hu JR, Lowenstern A, Frampton J, Abdullah A, Damluji AA, Ahmad Y, Soufer R, Nanna MG. Delirium in older adults after percutaneous coronary intervention: Prevalence, risks, and clinical phenotypes. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 57:60-67. [PMID: 37414611 PMCID: PMC10730763 DOI: 10.1016/j.carrev.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/02/2023] [Accepted: 06/13/2023] [Indexed: 07/08/2023]
Abstract
INTRODUCTION In-hospital delirium is more common among older adults and is associated with increased mortality and adverse health-related outcomes. We aim to establish the contemporary prevalence of delirium among older adults undergoing percutaneous coronary intervention (PCI) and the impact of delirium on in-hospital complications. METHODS We identified older adults aged ≥75 years in the National Inpatient Sample who underwent inpatient PCI for any reason from 2016 to 2020 and stratified them into those with and without delirium. The primary outcome was in-hospital mortality, and secondary outcomes encompassed post-procedural complications. RESULTS Delirium occurred in 14,130 (2.6 %) hospitalizations in which PCI was performed. Patients who developed delirium were older and had more comorbidities. Patients with in-hospital delirium had higher odds of in-hospital mortality (adjusted odds ratio [aOR] 1.27, p = 0.002) and non-home discharge (aOR 3.17, p < 0.001). Delirium was also associated with higher odds of intracranial hemorrhage (aOR 2.49, p < 0.001), gastrointestinal hemorrhage (aOR 1.25, p = 0.030), need for blood transfusion (aOR 1.52, p < 0.001), acute kidney injury (aOR 1.62, p < 0.001), and fall in hospital (aOR 1.97, p < 0.001). CONCLUSION Delirium among older adults undergoing PCI is relatively common and associated with higher odds of in-hospital mortality and adverse events. This highlights the importance of vigilant delirium prevention and early recognition in the peri-procedural setting, especially for older adults.
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Affiliation(s)
- Dae Yong Park
- Department of Medicine, Cook County Health, Chicago, IL, USA
| | - Yasser Jamil
- Department of Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Jiun-Ruey Hu
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Angela Lowenstern
- Section of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jennifer Frampton
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Ahmed Abdullah
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Abdulla A Damluji
- Johns Hopkins University School of Medicine, Baltimore, MD, USA; Inova Center of Outcomes Research, Falls Church, VA, USA
| | - Yousif Ahmad
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Robert Soufer
- Department of Medicine, Yale School of Medicine, New Haven, CT, USA; Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA; Department of Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
| | - Michael G Nanna
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA.
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Aono-Setoguchi H, Sakakura K, Jinnouchi H, Taniguchi Y, Tsukui T, Watanabe Y, Yamamoto K, Seguchi M, Wada H, Fujita H. Factors associated with intensive care unit delirium in patients with acute myocardial infarction. Heart Vessels 2023; 38:478-487. [PMID: 36399179 DOI: 10.1007/s00380-022-02200-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 11/09/2022] [Indexed: 11/19/2022]
Abstract
Some patients admitted to intensive care units (ICU) would develop delirium, which is associated with poor prognosis. The purpose of this retrospective study was to identify factors associated with ICU delirium in patients with acute myocardial infarction (AMI). We included 753 AMI and divided those into the ICU-delirium group (n = 110) and the non-ICU-delirium group (n = 643) according to the presence of ICU delirium. The ICU delirium was evaluated by confusion assessment method for the intensive care unit. Patient characteristics and clinical outcomes were compared between the 2 groups, and factors associated with ICU delirium were sought by multivariate analysis. The prevalence of female sex was significantly higher in the ICU-delirium group (43.6%) than in the non-ICU-delirium group (20.2%) (p < 0.001). The incidence of in-hospital death was significantly higher in the ICU-delirium group (17.3%) than in the non-ICU-delirium group (0.5%) (p < 0.001). The multivariate logistic regression analysis revealed that age [every 10 years increase: odds ratio (OR) 1.439, 95% confidence interval (CI) 1.127-1.837, p = 0.004], female sex (OR 2.237, 95%CI 1.300-3.849, p = 0.004), triple vessel disease (OR 2.317, 95%CI 1.365-3.932, p = 0.002), body mass index < 18.5 kg/m2 (OR 2.910, 95%CI 1.410-6.008, p = 0.004), use of mechanical support (OR 2.812, 95%CI 1.500-5.270, p = 0.001), respiratory failure (OR 5.342, 95%CI 3.080-9.265, p < 0.001), and use of continuous renal replacement therapy (OR 5.901, 95%CI 2.520-13.819, p < 0.001) were significantly associated with ICU delirium. In conclusion, ICU delirium was associated with in-hospital death. Older age, female sex, triple vessel disease, leanness, use of mechanical support, respiratory failure, and continuous renal replacement therapy were significantly associated with the occurrence of ICU delirium.
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Affiliation(s)
- Hitomi Aono-Setoguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City, 330-8503, Japan
| | - Kenichi Sakakura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City, 330-8503, Japan.
| | - Hiroyuki Jinnouchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City, 330-8503, Japan
| | - Yousuke Taniguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City, 330-8503, Japan
| | - Takunori Tsukui
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City, 330-8503, Japan
| | - Yusuke Watanabe
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City, 330-8503, Japan
| | - Kei Yamamoto
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City, 330-8503, Japan
| | - Masaru Seguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City, 330-8503, Japan
| | - Hiroshi Wada
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City, 330-8503, Japan
| | - Hideo Fujita
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City, 330-8503, Japan
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Wu N, Zhang Y, Wang S, Zhao Y, Zhong X. Incidence, prevalence and risk factors of delirium in
ICU
patients: A systematic review and meta‐analysis. Nurs Crit Care 2022. [DOI: 10.1111/nicc.12857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Nan‐Nan Wu
- The First Affiliated Hospital of Zhengzhou University Zhengzhou China
| | - Ya‐Bin Zhang
- The First Affiliated Hospital of Zhengzhou University Zhengzhou China
| | - Shu‐Yun Wang
- The First Affiliated Hospital of Zhengzhou University Zhengzhou China
| | - Yu‐Hua Zhao
- The First Affiliated Hospital of Zhengzhou University Zhengzhou China
| | - Xue‐Mei Zhong
- Guangdong Women and Children Hospital Guangzhou China
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Mędrzycka-Dąbrowska W, Lange S, Religa D, Dąbrowski S, Friganović A, Oomen B, Krupa S. Delirium in ICU Patients after Cardiac Arrest: A Scoping Review. J Pers Med 2022; 12:jpm12071047. [PMID: 35887544 PMCID: PMC9320343 DOI: 10.3390/jpm12071047] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/16/2022] [Accepted: 06/24/2022] [Indexed: 01/14/2023] Open
Abstract
Introduction: The incidence of delirium in the intensive care unit is high, although it may differ according to the specific characteristics of the unit. Despite the rapid development of research on delirium in recent years, the pathophysiological mechanisms leading to the clinical presentation of delirium are still subject to hypotheses. The aim of this review was to describe the incidence of delirium in cardiac arrest survivors and the clinical impact of delirium on patient outcomes. Methods: A scoping review was conducted in the second quarter of 2022. The number of articles retrieved during each search test was limited to studies conducted between 2010 and 2020. Strict inclusion and exclusion criteria were applied. The last search was conducted in May 2022. Results: A total of 537 records was initially obtained from the databases. After discarding duplicates, selecting titles and abstracts, and then analyzing full-text articles, 7 studies met the inclusion criteria. The incidence of delirium in the cardiac arrest survivor population ranged from 8% to as high as 100%. The length of stay in ICU and hospital was significantly longer in patients with delirium than those without. Ninety-eight percent of patients had cognitive or perceptual impairment and psychomotor impairment. Of the seven studies included in the analysis, the RASS, CAM, and NuDesc scales were used to diagnose delirium. Potential risk factors that may influence the duration of delirium include age and time since resuscitation; propofol use shortened the duration of delirium. Conclusion: the incidence of delirium in ICU patients who survived CA is high. Cardiac arrest is an additional predisposing factor for delirium. In cardiac arrest survivors, the occurrence of delirium prolongs the duration of ICU and hospital stay and adversely affects functional outcomes. The most common type of delirium among this population was hypoactive delirium. A large percentage of patients manifested symptoms such as cognitive or perception impairment, psychomotor impairment, and impaired concentration and attention.
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Affiliation(s)
- Wioletta Mędrzycka-Dąbrowska
- Department of Anaesthesiology Nursing & Intensive Care, Faculty of Health Sciences, Medical University of Gdansk, Dębinki 7, 80-211 Gdańsk, Poland
- Correspondence:
| | - Sandra Lange
- Department of Internal and Pediatric Nursing, Medical University of Gdańsk, Dębinki 7, 80-211 Gdańsk, Poland;
| | - Dorota Religa
- Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, 17177 Stockholm, Sweden;
| | - Sebastian Dąbrowski
- Departament of Medical Rescue, Faculty of Health Sciences, Medical University of Gdańsk, Dębinki 7, 80-211 Gdańsk, Poland;
| | - Adriano Friganović
- Department of Anesthesiology and Intensive Medicine, University Hospital Centre Zagreb, 10000 Zagreb, Croatia;
- Department of Nursing, University of Applied Health Sciences, Mlinarska Cesta 38, 10000 Zagreb, Croatia
| | - Ber Oomen
- European Specialist Nurses Organisation (ESNO), 6821HR Arnhem, The Netherlands;
| | - Sabina Krupa
- Institute of Health Sciences, College of Medical Sciences of the University of Rzeszow, St. Warzywna 1A, 35-310 Rzeszow, Poland;
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Association of dementia with in-hospital outcomes in primary heart failure and acute myocardial infarction hospitalizations. Prog Cardiovasc Dis 2022; 73:24-31. [PMID: 35718115 DOI: 10.1016/j.pcad.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 06/12/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Dementia and cardiovascular diseases contribute to a significant disability and healthcare utilization in the elderly. OBJECTIVE The in-hospital treatment patterns and outcomes of heart failure (HF) and acute myocardial infarction (AMI) are not well-studied in this population. METHODS We used the National Inpatient Sample database to identify AMI and HF hospitalizations in adults ≥65 years between 2016 and 2018. RESULTS A total of 2,466,369 HF hospitalizations (277,900 with dementia [11.3%]) and 1,094,155 AMI hospitalizations (100,365 with dementia [9.2%]) were identified. Patients with dementia were older (mean age 83.8 vs 78.6 years for HF, and 83.0 vs 75.8 years for AMI) with female predominance (59.0% for HF and 56.0% for AMI) than those without dementia. In adjusted analysis, patients with dementia had higher in-hospital mortality (HF 4.7% vs 3.1%, aOR 1.33 [1.27-1.39] and AMI 9.9% vs 5.9%, aOR 1.23 [1.17-1.30]), p < 0.001) and lower mechanical circulatory support utilization. Patients with AMI and dementia were less likely to receive revascularization (including percutaneous coronary intervention, coronary artery bypass grafting, and thrombolysis), vasopressors, and invasive mechanical ventilation. They had a longer mean length of stay (LOS) (5.5 vs 5.3 days for HF and 5.1 vs 4.8 days for AMI, p < 0.001 for both), a lower inflation-adjusted cost of care for AMI ($15,486 vs $23,215, p < 0.001), and higher rates of transfer to rehabilitation facilities. CONCLUSION Patients with dementia admitted for HF or AMI had higher in-hospital mortality, a longer LOS, and were less likely to receive aggressive revascularization interventions after AMI.
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Jäckel M, Aicher N, Bemtgen X, Rilinger J, Zotzmann V, Biever PM, Supady A, Stachon P, Duerschmied D, Wengenmayer T, Bode C, Staudacher DL. Advantages of score-based delirium detection compared to a clinical delirium assessment-a retrospective, monocentric cohort study. PLoS One 2021; 16:e0259841. [PMID: 34843524 PMCID: PMC8629257 DOI: 10.1371/journal.pone.0259841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 10/28/2021] [Indexed: 11/19/2022] Open
Abstract
Purpose Delirium is an underdiagnosed complication on intensive care units (ICU). We hypothesized that a score-based delirium detection using the Nudesc score identifies more patients compared to a traditional diagnosis of delirium by ICU physicians. Methods In this retrospective study, all patients treated on a general medical ICU with 30 beds in a university hospital in 2019 were analyzed. Primary outcome was a documented physician diagnosis of delirium, or a delirium score ≥2 using the Nudesc. Results In 205/943 included patients (21.7%), delirium was diagnosed by ICU physicians compared to 438/943 (46.4%; ratio 2.1) by Nudesc≥2. Both assessments were independent predictors of ICU stay (p<0.01). The physician diagnosis however was no independent predictor of mortality (OR 0.98 (0.57–1.72); p = 0.989), in contrast to the score-based diagnosis (OR 2.31 (1.30–4.10); p = 0.004). Subgroup analysis showed that physicians underdiagnosed delirium in case of hypoactive delirium and delirium in patients with female gender and in patients with an age below 60 years. Conclusion Delirium in patients with hypoactive delirium, female patients and those below 60 years was underdiagnosed by physicians. The score-based delirium diagnosis detected delirium more frequently and correlated with ICU mortality and stay.
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Affiliation(s)
- Markus Jäckel
- Faculty of Medicine, Department of Cardiology and Angiology I, Heart Center Freiburg University, University of Freiburg, Freiburg, Germany
- Faculty of Medicine, Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Nico Aicher
- Faculty of Medicine, Department of Cardiology and Angiology I, Heart Center Freiburg University, University of Freiburg, Freiburg, Germany
- Faculty of Medicine, Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Xavier Bemtgen
- Faculty of Medicine, Department of Cardiology and Angiology I, Heart Center Freiburg University, University of Freiburg, Freiburg, Germany
- Faculty of Medicine, Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Jonathan Rilinger
- Faculty of Medicine, Department of Cardiology and Angiology I, Heart Center Freiburg University, University of Freiburg, Freiburg, Germany
- Faculty of Medicine, Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Viviane Zotzmann
- Faculty of Medicine, Department of Cardiology and Angiology I, Heart Center Freiburg University, University of Freiburg, Freiburg, Germany
- Faculty of Medicine, Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Paul Marc Biever
- Faculty of Medicine, Department of Cardiology and Angiology I, Heart Center Freiburg University, University of Freiburg, Freiburg, Germany
- Faculty of Medicine, Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Alexander Supady
- Faculty of Medicine, Department of Cardiology and Angiology I, Heart Center Freiburg University, University of Freiburg, Freiburg, Germany
- Faculty of Medicine, Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Peter Stachon
- Faculty of Medicine, Department of Cardiology and Angiology I, Heart Center Freiburg University, University of Freiburg, Freiburg, Germany
- Faculty of Medicine, Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Daniel Duerschmied
- Faculty of Medicine, Department of Cardiology and Angiology I, Heart Center Freiburg University, University of Freiburg, Freiburg, Germany
- Faculty of Medicine, Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Tobias Wengenmayer
- Faculty of Medicine, Department of Cardiology and Angiology I, Heart Center Freiburg University, University of Freiburg, Freiburg, Germany
- Faculty of Medicine, Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Christoph Bode
- Faculty of Medicine, Department of Cardiology and Angiology I, Heart Center Freiburg University, University of Freiburg, Freiburg, Germany
- Faculty of Medicine, Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Dawid Leander Staudacher
- Faculty of Medicine, Department of Cardiology and Angiology I, Heart Center Freiburg University, University of Freiburg, Freiburg, Germany
- Faculty of Medicine, Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, University of Freiburg, Freiburg, Germany
- * E-mail:
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Jäckel M, Aicher N, Biever PM, Heine L, Bemtgen X, Rilinger J, Zotzmann V, Supady A, Stachon P, Wengenmayer T, Bode C, Staudacher DL. Delirium in Critically Ill Patients with and without COVID-19-A Retrospective Analysis. J Clin Med 2021; 10:jcm10194412. [PMID: 34640428 PMCID: PMC8509381 DOI: 10.3390/jcm10194412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/22/2021] [Accepted: 09/24/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Delirium complicating the course of Intensive care unit (ICU) therapy is a known driver of morbidity and mortality. It has been speculated that infection with the neurotrophic SARS-CoV-2 might promote delirium. METHODS Retrospective registry analysis including all patients treated at least 48 h on a medical intensive care unit. The primary endpoint was development of delirium as diagnosed by Nursing Delirium screening scale ≥2. Results were confirmed by propensity score matching. RESULTS 542 patients were included. The primary endpoint was reached in 352/542 (64.9%) patients, without significant differences between COVID-19 patients and non-COVID-19 patients (51.4% and 65.9%, respectively, p = 0.07) and correlated with prolonged ICU stay in both groups. In a subgroup of patients with ICU stay >10 days delirium was significantly lower in COVID-19 patients (p ≤ 0.01). After adjustment for confounders, COVID-19 correlated independently with less ICU delirium (p ≤ 0.01). In the propensity score matched cohort, patients with COVID-19 had significantly lower delirium incidence compared to the matched control patients (p ≤ 0.01). CONCLUSION Delirium is frequent in critically ill patients with and without COVID-19 treated at an intensive care unit. Data suggests that COVID-19 itself is not a driver of delirium per se.
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Affiliation(s)
- Markus Jäckel
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (N.A.); (P.M.B.); (L.H.); (X.B.); (J.R.); (V.Z.); (A.S.); (P.S.); (T.W.); (C.B.); (D.L.S.)
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
- Correspondence:
| | - Nico Aicher
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (N.A.); (P.M.B.); (L.H.); (X.B.); (J.R.); (V.Z.); (A.S.); (P.S.); (T.W.); (C.B.); (D.L.S.)
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Paul Marc Biever
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (N.A.); (P.M.B.); (L.H.); (X.B.); (J.R.); (V.Z.); (A.S.); (P.S.); (T.W.); (C.B.); (D.L.S.)
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Laura Heine
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (N.A.); (P.M.B.); (L.H.); (X.B.); (J.R.); (V.Z.); (A.S.); (P.S.); (T.W.); (C.B.); (D.L.S.)
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Xavier Bemtgen
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (N.A.); (P.M.B.); (L.H.); (X.B.); (J.R.); (V.Z.); (A.S.); (P.S.); (T.W.); (C.B.); (D.L.S.)
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Jonathan Rilinger
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (N.A.); (P.M.B.); (L.H.); (X.B.); (J.R.); (V.Z.); (A.S.); (P.S.); (T.W.); (C.B.); (D.L.S.)
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Viviane Zotzmann
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (N.A.); (P.M.B.); (L.H.); (X.B.); (J.R.); (V.Z.); (A.S.); (P.S.); (T.W.); (C.B.); (D.L.S.)
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Alexander Supady
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (N.A.); (P.M.B.); (L.H.); (X.B.); (J.R.); (V.Z.); (A.S.); (P.S.); (T.W.); (C.B.); (D.L.S.)
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Peter Stachon
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (N.A.); (P.M.B.); (L.H.); (X.B.); (J.R.); (V.Z.); (A.S.); (P.S.); (T.W.); (C.B.); (D.L.S.)
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Tobias Wengenmayer
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (N.A.); (P.M.B.); (L.H.); (X.B.); (J.R.); (V.Z.); (A.S.); (P.S.); (T.W.); (C.B.); (D.L.S.)
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Christoph Bode
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (N.A.); (P.M.B.); (L.H.); (X.B.); (J.R.); (V.Z.); (A.S.); (P.S.); (T.W.); (C.B.); (D.L.S.)
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Dawid Leander Staudacher
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (N.A.); (P.M.B.); (L.H.); (X.B.); (J.R.); (V.Z.); (A.S.); (P.S.); (T.W.); (C.B.); (D.L.S.)
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
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Incidence and predictors of delirium on the intensive care unit in patients with acute kidney injury, insight from a retrospective registry. Sci Rep 2021; 11:17260. [PMID: 34446816 PMCID: PMC8390667 DOI: 10.1038/s41598-021-96839-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 08/17/2021] [Indexed: 11/12/2022] Open
Abstract
Acute kidney injury (AKI) and delirium are common complications on the intensive care unit (ICU). Few is known about the association of AKI and delirium, as well as about incidence and predictors of delirium in patients with AKI. In this retrospective study, all patients with AKI, as defined by the KDIGO (kidney disease improving global outcome) guideline, treated for more than 24 h on the ICU in an university hospital in 2019 were included and analyzed. Delirium was defined by a NuDesc (Nursing Delirium screening scale) ≥ 2, which is evaluated three times a day in every patient on our ICU as part of daily routine. A total of 383/919 (41.7%) patients developed an AKI during the ICU stay. Delirium was detected in 230/383 (60.1%) patients with AKI. Independent predictors of delirium were: age, psychiatric disease, alcohol abuse, mechanical ventilation, severe shock, and AKI stage II/III (all p < 0.05). The primary cause of illness had no influence on the onset of delirium. Among patients with AKI, the duration of the ICU stay correlated with higher stages of AKI and the presence of delirium (stage I/no delirium: median 1.9 (interquartile range (25th–75th) 1.3–2.9) days; stage II/III/no delirium: 2.6 (1.6–5.5) days; stage I/delirium: 4.1 (2.5–14.3) days; stage II/III/delirium: 6.8 (3.5–11.9) days; all p < 0.01). Delirium, defined as NuDesc ≥ 2 is frequent in patients with AKI on an ICU and independently predicted by higher stages of AKI.
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