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Informaciones
Psiquiátricas
2019 - n.º
235
(21.2) días y e tiempo para desarollo de
delirium fue de 15 días. Fueron éxitus 11
sujetos (5.7%). Los principales predictores
de mortalidad global, ajustados por edad e
índice de Charlson, fueron: Delirium HR:5.26
(95%CI 1.30-21.29) y derivación desde Ur-
gencias (Subagudos) HR:5.34 (95%CI 1.62-
17.56).
Conclusión
: Las variables relacionadas
con deterioro cognitivo fueron las más im-
portantes relacionadas con el desarrollo de
delirium en una unidad de convalescencia. El
delirium es un factor independiente de mor-
talidad en estas unidades.
Palabras clave:
Delirium, Déficit cognitivo,
mortalidad.
Abstract
PREVALENCE OF THE FIRST EPISODE OF
DELIRIUM, RELATED FACTORS AND THEIR
IMPACT ON MORTALITY, IN PATIENTS
ADMITTED IN A CONVALESCENCE UNIT
Objectives
: To determine the prevalence
of the first episode of delirium in patients
older than 65 years, its impact on mortality
and related factors.
Methods
: Prospective and cross-sectional
study. During 4 months of follow-up, patients
older than 65 years admitted in a post-acute
convalescence unit were included. Using a
questionnaire, we studied probable predispo-
sing factors (visual and hearing impairment,
psychoactive drugs) and precipitating fac-
tors (bladder catheter, fever, poor control of
pain and sleep disturbances). Additionally,
demographic data, comorbidity, pre-existing
cognitive impairment and physical function
were recorded. Subjects with advanced de-
mentia, diagnosis of any organic encephalo-
pathy or evidence of delirium at the time of
the admission were excluded. Delirium was
defined according the Confusion Assessment
Method. The factors associated with delirium
were studied by a multivariate analysis per-
formed by logistic regression. A multivariate
Cox proportional hazards regression analysis
was used to examine predictors of mortality
with competing endpoints (death and dis-
charge alive) and estimated both the daily
hazard and cumulative risk of death.
Results
: A total of 195 patients received
follow-up during the observation period. A
39% (76/195) were men (mean 82.1 years).
Admission Barthel index score was 45 (IQR
25-60) and Charlson comorbidity score was
2 (IQR 1-4). A 21% (41/195) had presen-
ted history of delirium prior. Prevalence of
first episode of delirium was 23.1% (95% CI:
17.7-29.5). Principal related factors to de-
lirium were: Age OR:1.6 (95%CI 1.01-1.11),
total errors according Pfeiffer's Test OR:1.4
(95%CI 1.2-1.64) and Charlson comorbidity
score OR:1.25 (95%CI 1.02-1.53). Mean time
for development of delirium was 15 days and
average time for hospital discharge was 37.1
days. 11 subjects (5.7%) died during follow-
up. Adjusted by age and Charlson score,
main predictors for mortality were: Delirium
HR:5.26 (95%CI 1.30-21.29) and derivation
from emergency room HR:5.34 (95%CI 1.62-
17.56).
Conclusions
: Associated variables with
cognitive impairment were the most impor-
tant with development of first episode of de-
lirium in a convalescence unit. Delirium is
an independent factor of mortality in these
units.
Key Words:
Delirium, cognitive impairment,
mortality.
Javier Santolaria Giner / Alvaro José Betancourt / Paula Ariana Bozin