Poor outcomes of delirium in the intensive care units are amplified by increasing age: A retrospective cohort study

doi:10.5847/wjem.j.1920-8642.2021.02.006

Abstract

Abstract:

BACKGROUND: Delirium in patients in intensive care units (ICUs) is an acute disturbance and fluctuation of cognition and consciousness. Though increasing age has been found to be related to ICU delirium, there is limited evidence of the effect of age on delirium outcomes. The aim of this study is to investigate the relationship between age categories and outcomes among ICU delirium patients.

METHODS: Data were extracted from the electronic ICU (eICU) Collaborative Research Database with records from 3,931 patients with delirium. Patients were classified into non-aged (<65 years), young-old (65-74 years), middle-old (75-84 years), and very-old (≥85 years) groups. A Cox regression model was built to examine the role of age in death in ICU and in hospital after controlling covariates.

RESULTS: The sample included 1,667 (42.4%) non-aged, 891 (22.7%) young-old, 848 (21.6%) middle-old, and 525 (13.3%) very-old patients. The ICU mortality rate was 8.3% and the hospital mortality rate was 15.4%. Compared with the non-aged group, the elderly patients (≥65 yeras) had higher mortality at ICU discharge (χ ²=13.726, P=0.001) and hospital discharge (χ ²=56.347, P<0.001). The Cox regression analysis showed that age was an independent risk factor for death at ICU discharge (hazard ratio [HR]=1.502, 1.675, 1.840, 95% confidence interval [CI] 1.138-1.983, 1.250-2.244, 1.260-2.687; P=0.004, 0.001, 0.002 for the young-, middle- and very-old group, respectively) as well as death at hospital discharge (HR=1.801, 2.036, 2.642, 95% CI 1.454-2.230, 1.638-2.530, 2.047-3.409; all P<0.001).

CONCLUSIONS: The risks of death in the ICU and hospital increase with age among delirious patients.

Key words: Intensive care, Delirium, Aging, Mortality

Wen Gao, Yu-ping Zhang, Jing-fen Jin. Poor outcomes of delirium in the intensive care units are amplified by increasing age: A retrospective cohort study[J]. World Journal of Emergency Medicine, 2021, 12(2): 117-123.

Figures/Tables 3

Figure 1.

Table 1

Characteristics of ICU delirium patients in different age groups

Variables	Total (n=3,931)	Non-aged group (n=1,667)	Young-old group (n=891)	Middle-old group (n=848)	Very-old group (n=525)	χ²/F	P-value
Male, n (%)	2,095 (53.3)	950 (57.0)	505 (56.7)	416 (49.1)	224 (42.7)	43.178	<0.001
Caucasian, n (%)	3,086 (75.9)	1,270 (76.2)	720 (80.8)	671 (79.1)	425 (81.0)	99.837	<0.001
Medical history, n (%)
Dementia	298 (7.6)	15 (0.9)	42 (4.7)	122 (14.4)	119 (22.7)	343.263	<0.001
Hypertension	2,389 (60.8)	804 (48.2)	614 (68.9)	596 (70.3)	375 (71.4)	191.937	<0.001
Diabetes	572 (14.6)	240 (14.4)	160 (18.0)	130 (15.3)	42 (8.0)	26.881	<0.001
Stroke	463 (11.8)	145 (8.7)	108 (12.1)	137 (16.2)	73 (13.9)	33.242	<0.001
Urgent admission, n (%)	1,815 (46.2)	775 (46.5)	385 (43.2)	386 (45.5)	269 (51.2)	8.781	0.032
APACHE IV score, mean±SD	69.20±26.27	64.07±27.50	71.60±25.90	72.53±25.06	76.05±21.39	41.358	<0.001
Ventilation, n (%)	1,942 (49.4)	929 (55.7)	465 (52.2)	370 (43.6)	178 (33.9)	91.199	<0.001
Metabolic acidosis, n (%)	165 (4.2)	81 (4.9)	37 (4.2)	29 (3.4)	18 (3.5)	3.866	0.276
Sepsis, n (%)	440 (11.2)	178 (10.7)	97 (10.9)	93 (11.0)	72 (13.7)	3.930	0.269
ARDS, n (%)	310 (7.9)	125 (7.5)	71 (8.0)	60 (7.1)	54 (10.3)	5.282	0.152
Sedatives, n (%)
Dexmedetomidine	344 (8.8)	181 (10.9)	64 (7.2)	73 (8.6)	26 (5.0)	21.518	<0.001
Propofol	614 (15.6)	303 (18.2)	133 (14.9)	130 (15.3)	48 (9.1)	25.356	<0.001
Benzodiazepines	258 (6.6)	142 (8.5)	53 (5.9)	46 (5.4)	17 (3.2)	22.198	<0.001
Mortality, n (%)
Intensive care unit	325 (8.3)	112 (6.7)^*	95 (10.7)^*	79 (9.3)^*	39 (7.4)^*	13.726	0.003
Hospital	606 (15.4)	173 (10.4)^*	170 (19.1)^*	162 (19.1)^*	101 (19.2)^*	56.347	<0.001
LOS, days, mean±SD
Intensive care unit^a	4.345±2.228	4.700±2.307^*	4.656±2.234^*	4.083±2.158^*	3.350±1.905^*	28.156	<0.001
Hospital^a	8.147±2.137	8.610±2.254^*	8.551±2.104^*	7.870±2.070^*	6.700±1.858^*	16.510	<0.001
Ventilation-free days, mean±SD	4.188±2.193	4.560±2.270^*	4.457±2.213^*	3.873±2.133^*	3.304±1.884^*	22.769	<0.001

Table 1

Table 2

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Variables	Cox regression model 1 (ICU mortality)		Cox regression model 2 (Hospital mortality)
Variables	HR (95% CI)	P-value	HR (95% CI)	P-value
Age group
Non-aged	1 (reference)		1 (reference)
Young-old	1.502 (1.138-1.983)	0.004	1.801 (1.454-2.230)	<0.001
Middle-old	1.675 (1.250-2.244)	0.001	2.036 (1.638-2.530)	<0.001
Very-old	1.840 (1.260-2.687)	0.002	2.642 (2.047-3.409)	<0.001
APACHE IV score	1.010 (1.010-1.018)	<0.001	1.013 (1.010-1.016)	<0.001
Ventilation	1.065 (0.810-1.400)	0.654	1.294 (1.070-1.566)	0.008
Sepsis	1.492 (1.115-1.996)	0.007	1.396 (1.122-1.735)	0.003
Dexmedetomidine	0.449 (0.294-0.684)	<0.001	0.652 (0.485-0.877)	0.005

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