Incidence and predictors of delirium among the intensive care unit patients at Jimma Medical Center, Southwest Ethiopia
-
Asaminew Habtamu
,
Taye Mezgebu
,
Abdeta Workina
,
Bulcha Lemma
,
feyissa Tolessa
,
Edmialem Getahun
,
Adebabay Wondimagegn
,
Achalu Kelbessa
,
Fikadu Abebe
Abstract
Objective: Delirium is characterized by impaired attention and awareness, accompanied by cognitive deficits. It develops rapidly and poses a considerable burden on healthcare systems. Patients in the intensive care unit (ICU) are particularly vulnerable to developing delirium. This study aims to determine the incidence and predictors of delirium among ICU patients at Jimma Medical Center in southwest Ethiopia in 2023. Methods: A prospective observational cohort study was conducted on 403 patients aged≥18 years admitted to emergency, surgical, and medical ICUs at Jimma Medical Center in southwest Ethiopia. Patients were assessed twice daily for delirium using the Richmond agitation sedation scale (RASS) and confusion assessment method (CAM). The association between independent variables and delirium incidence was analyzed using Cox proportional hazards (PH) regression. A univariate Cox PH model screened variables at a 0.25 significance level, followed by a multivariable Cox PH model for significant variables. Variables with a P-value≤0.05 were considered significantly associated with delirium incidence among ICU patients. Results: The findings of this study revealed that the overall occurrence of delirium among critically ill ICU patients was 118 (29.3%) (95% CI: 25%,34%), and the rest, 70.7% of the participants, were censored (95% CI: 66,75). The incidence rate of delirium among intensive care unit patients was 21.2 (95% CI: 17.8,25.4) per 1000 person-days of observation. Chronic obstructive pulmonary disease (AHR: 1.94; 95% CI: 1.23,3.56), stroke (AHR: 1.8; 95%CI: 1.98,3.73), Oxygen Saturation less than 90% (AHR:1.61; 95% CI: 1.11,2.34) and Obesity (AHR: 0.35; 95%CI: 0.13,0.84) were independent predictors of delirium among ICU patients. conclusion: This study found that, with an incidence rate of 21.2 occurrences per 1000 person-days of observation, delirium greatly affects the outcome of intensive care unit patients in the Jimma Medical Center. The study identifies several factors that independently predict the occurrence of delirium in ICU patients, including obesity, stroke, low oxygen saturation levels, and COPD. Interestingly, our findings suggest that admission for heart failure may have a protective effect against delirium. Therefore, health professionals ought to give special attention to patients with identified predictors.
1. Rajabpour Nikfam M, Ghanbari Khanghah A, Khaleghdoost Mohammadi T, Kazemnezhad Leili E, Ashraf A. Study of predictors of delirium incidence in hospitalized patients in intensive care units. J Holist Nurs Midwifery. 2016;26(3):25-35.
2. Fournier A, Krause R, Winterer G, Schneider R. Biomarkers of postoperative delirium and cognitive dysfunction. Front Aging Neurosci. 2015;7:112.
3. Wang HR, Woo YS, Bahk WM. Atypical antipsychotics in the treatment of delirium. Psychiatry Clin Neurosci. 2013;67(5):323-31.
4. Witlox J, Eurelings LS, de Jonghe JF, Kalisvaart KJ, Eikelenboom P, van Gool WA. Delirium in elderly patients and the risk of post discharge mortality, institutionalization, and dementia: a meta-analysis. JAMA. 2010;304(4):443-51.
5. Mart MF, Pun BT, Pandharipande P, Jackson JC, Ely EW. ICU Survivorship-the relationship of delirium, sedation, dementia, and acquired weakness. Crit Care Med. 2021;49(8):1227-40.
6. Chakraborti D, Tampi DJ, Tampi RR. Melatonin and melatonin agonist for delirium in elderly patients. Am J Alzheimers Dis Other Demen. 2015;30(2):119-29.
7. Inouye SK, Westendorp RGJ, Saczynski JS. Delirium in elderly people. Lancet Lond Engl. 2014;383(9920):911-22.
8. Vasilevskis EE, Han JH, Hughes CG, Ely EW. Epidemiology and risk factors for delirium across hospital settings. Best Pract Res Clin Anaesthesiol. 2012;26(3):277-87.
9. Rahimi-Bashar F, Abolhasani G, Manouchehrian N, Jiryaee N, Vahedian-Azimi A, Sahebkar A. Incidence and risk factors of delirium in the intensive care unit: a prospective cohort. BioMed Res Int. 2021;2021:e6219678.
10. Ahmed S, Leurent B, Sampson EL. Risk factors for incident delirium among older people in acute hospital medical units: a systematic review and meta-analysis. Age Ageing. 2014;43(3):326-33.
11. Grover S, Chakrabarti S, Shah R, Kumar V. A factor analytic study of the delirium rating scale-revised-98 in untreated patients with delirium. J Psychosom Res. 2011;70(5):473-8.
12. Grover S, Kumar V, Chakrabarti S. Comparative efficacy study of haloperidol, olanzapine and risperidone in delirium. J Psychosom Res. 2011;71(4):277-81.
13. Grover S, Subodh BN, Avasthi A, et al. Prevalence and clinical profile of delirium: a study from a tertiary-care hospital in north India. Gen Hosp Psychiatry. 2009;31(1):25-9.
14. Jain G, Chakrabarti S, Kulhara P. Symptoms of delirium: an exploratory factor analytic study among referred patients. Gen Hosp Psychiatry. 2011;33(4):377-85.
15. Kallenbach T, Amado L. Assessment of delirium in the intensive care unit. South Afr J Anaesth Analg. 2017;23(3):57-63.
16. Elie M, Rousseau F, Cole M, Primeau F, McCusker J, Bellavance F. Prevalence and detection of delirium in elderly emergency department patients. CMAJ Can Med Assoc J J Assoc Medicale Can. 2000;163(8):977-81.
17. Kiely D, Bergmann M, Murphy K, Jones R, Orav E, Marcantonio E. Delirium among newly admitted postacute facility patients: prevalence, symptoms, and severity. J Gerontol A Biol Sci Med Sci. 2003;58:M441-5.
18. McNicoll L, Pisani MA, Zhang Y, Ely EW, Siegel MD, Inouye SK. Delirium in the intensive care unit: occurrence and clinical course in older patients. J Am Geriatr Soc. 2003;51(5):591-8.
19. Lawlor PG, Gagnon B, Mancini IL, Pereira JL, Hanson J, Suarez-Almazor ME, et al. Occurrence, causes, and outcome of delirium in patients with advanced cancer: a prospective study. Arch Intern Med. 2000;160(6):786-94.
20. Rudolph JL, Marcantonio ER. Review articles: postoperative delirium: acute change with long-term implications. Anesth Analg. 2011;112(5):1202-11.
21. Tema NSZ, Janse Van Rensburg ABR. Psychiatric consultations and the management of associated comorbid medical conditions in a regional referral hospital. South Afr J Psychiatry. 2015;21(2):6.
22. van den Boogaard M, Peters SA, van der Hoeven JG, et al. The impact of delirium on the prediction of in-hospital mortality in intensive care patients. Crit Care. 2010;14(4):R146.
23. Salluh JI, Soares M, Teles JM, et al. Delirium epidemiology in critical care (DECCA): an international study. Crit Care. 2010;14(6):R210.
24. Pisani MA, Kong SY, Kasl SV, Murphy TE, Araujo KL, Van Ness PH. Days of delirium are associated with 1-year mortality in an older intensive care unit population. Am J Respir Crit Care Med. 2009;180(11):1092-7.
25. Girard TD, Jackson JC, Pandharipande PP, et al. Delirium as a predictor of long-term cognitive impairment in survivors of critical illness. Crit Care Med. 2010;38(7):1513-20.
26. Ely EW, Inouye SK, Bernard GR, et al. Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). JAMA. 2001;286(21):2703-10./
27. Dubois MJ, Bergeron N, Dumont M, Dial S, Skrobik Y. Delirium in an intensive care unit: a study of risk factors. Intensive Care Med. 2001;27(8):1297-1304.
28. McNicoll L, Pisani MA, Zhang Y, Ely EW, Siegel MD, Inouye SK. Delirium in the intensive care unit: occurrence and clinical course in older patients. J Am Geriatr Soc. 2003;51(5):591-8.
29. Pandharipande P, Shintani A, Peterson J, Pun BT, Wilkinson GR, Dittus RS, et al. Lorazepam is an independent risk factor for transitioning to delirium in intensive care unit patients. Anesthesiology. 2006;104(1):21-6.
30. Jackson JC, Gordon SM, Hart RP, Hopkins RO, Ely EW. The association between delirium and cognitive decline: a review of the empirical literature. Neuropsychol Rev. 2004;14(2):87-98.
31. Ní Chróinín D, Alexandrou E, Frost SA. Delirium in the intensive care unit and its importance in the post-operative context: a review. Front Med. 2023;10:1071854.
32. Mart MF, Williams Roberson S, Salas B, Pandharipande PP, Ely EW. Prevention and management of delirium in the intensive care unit. Semin Respir Crit Care Med. 2021;42(1):112-26.
33. Miranda F, Gonzalez F, Plana MN, Zamora J, Quinn TJ, Seron P. Confusion assessment method for the intensive care unit (CAM-ICU) for the diagnosis of delirium in adults in critical care settings. Cochrane Database Syst Rev. 2023;11(11):CD013126.
34. Bergeron N, Dubois MJ, Dumont M, Dial S, Skrobik Y. Intensive care delirium screening checklist: evaluation of a new screening tool. Intensive Care Med. 2001;27(5):859-64.
35. Elm E. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med. 2007;147:573.
36. Rahimi-Bashar F, Abolhasani G, Manouchehrian N, Jiryaee N, Vahedian-Azimi A, Sahebkar A. Incidence and Risk Factors of Delirium in the Intensive Care Unit: A Prospective Cohort. BioMed Res Int. 2021 Jan 8;2021:6219678.
37. Pan Y, Yan J, Jiang Z, Luo J, Zhang J, Yang K. Incidence, risk factors, and cumulative risk of delirium among ICU patients: acase-control study. Int J Nurs Sci. 2019;6(3):247-51.
38. Alzoubi E, Shaheen F, Yousef K. Delirium incidence, predictors and outcomes in the intensive care unit: a prospective cohort study. Int J Nurs Pract. 2023;30(1):e13154.
39. Jäckel M, Zotzmann V, Wengenmayer T, Duerschmied D, Biever PM, Spieler D, et al. Incidence and predictors of delirium on the intensive care unit after acute myocardial infarction, insight from a retrospective registry. Catheter Cardiovasc Interv. 2021;98(6):1072-81.
40. Ko Y, Kim HE, Park JY, Kim JJ, Cho J, Oh J. Relationship between body mass index and risk of delirium in an intensive care unit. Arch Gerontol Geriatr. 2023;108:104921.
41. Wood MD, Maslove DM, Muscedere JG, Day AG, Gordon Boyd J. Low brain tissue oxygenation contributes to the development of delirium in critically ill patients: a prospective observational study. J Crit Care. 2017;41:289-95.
42. Deschamps A, Hall R, Grocott H, Mazer CD, Choi PT, Turgeon AF, et al. Cerebral oximetry monitoring to maintain normal cerebral oxygen saturation during high-risk cardiac surgery. Anesthesiology. 2016;124(4):826-36.
43. Agarwal AK, Raja A, Brown BD. Chronic obstructive pulmonary disease. In: StatPearls. Treasure Island (FL): StatPearls Publishing; August 7, 2023.
44. Correale M, Altamura M, Carnevale R, Tricarico L, Malerba S, Gallotta AM, et al. Delirium in heart failure. Heart Fail Rev. 2020;25(5):713-23.
45. Niu Z, Zhou J, Li Y. Prognostic significance of delirium in patients with heart failure: a systematic review and meta-analysis. Front Cardiovasc Med. 2023;10:1217965.
46. Ibrahim K, McCarthy CP, McCarthy KJ, et al. Delirium in the cardiac intensive care unit. J Am Heart Assoc. 2018;7(4):e008568.
47. Ashine TM, Heliso AZ, Babore GO, Ezo E, Saliya SA, Birehanu Muluneh B, et al. Incidence and predictors of cardiac arrest among patients admitted to the intensive care units of a comprehensive specialized hospital in Central Ethiopia. Patient Relat Outcome Meas. 2023;15:31-43.
2. Fournier A, Krause R, Winterer G, Schneider R. Biomarkers of postoperative delirium and cognitive dysfunction. Front Aging Neurosci. 2015;7:112.
3. Wang HR, Woo YS, Bahk WM. Atypical antipsychotics in the treatment of delirium. Psychiatry Clin Neurosci. 2013;67(5):323-31.
4. Witlox J, Eurelings LS, de Jonghe JF, Kalisvaart KJ, Eikelenboom P, van Gool WA. Delirium in elderly patients and the risk of post discharge mortality, institutionalization, and dementia: a meta-analysis. JAMA. 2010;304(4):443-51.
5. Mart MF, Pun BT, Pandharipande P, Jackson JC, Ely EW. ICU Survivorship-the relationship of delirium, sedation, dementia, and acquired weakness. Crit Care Med. 2021;49(8):1227-40.
6. Chakraborti D, Tampi DJ, Tampi RR. Melatonin and melatonin agonist for delirium in elderly patients. Am J Alzheimers Dis Other Demen. 2015;30(2):119-29.
7. Inouye SK, Westendorp RGJ, Saczynski JS. Delirium in elderly people. Lancet Lond Engl. 2014;383(9920):911-22.
8. Vasilevskis EE, Han JH, Hughes CG, Ely EW. Epidemiology and risk factors for delirium across hospital settings. Best Pract Res Clin Anaesthesiol. 2012;26(3):277-87.
9. Rahimi-Bashar F, Abolhasani G, Manouchehrian N, Jiryaee N, Vahedian-Azimi A, Sahebkar A. Incidence and risk factors of delirium in the intensive care unit: a prospective cohort. BioMed Res Int. 2021;2021:e6219678.
10. Ahmed S, Leurent B, Sampson EL. Risk factors for incident delirium among older people in acute hospital medical units: a systematic review and meta-analysis. Age Ageing. 2014;43(3):326-33.
11. Grover S, Chakrabarti S, Shah R, Kumar V. A factor analytic study of the delirium rating scale-revised-98 in untreated patients with delirium. J Psychosom Res. 2011;70(5):473-8.
12. Grover S, Kumar V, Chakrabarti S. Comparative efficacy study of haloperidol, olanzapine and risperidone in delirium. J Psychosom Res. 2011;71(4):277-81.
13. Grover S, Subodh BN, Avasthi A, et al. Prevalence and clinical profile of delirium: a study from a tertiary-care hospital in north India. Gen Hosp Psychiatry. 2009;31(1):25-9.
14. Jain G, Chakrabarti S, Kulhara P. Symptoms of delirium: an exploratory factor analytic study among referred patients. Gen Hosp Psychiatry. 2011;33(4):377-85.
15. Kallenbach T, Amado L. Assessment of delirium in the intensive care unit. South Afr J Anaesth Analg. 2017;23(3):57-63.
16. Elie M, Rousseau F, Cole M, Primeau F, McCusker J, Bellavance F. Prevalence and detection of delirium in elderly emergency department patients. CMAJ Can Med Assoc J J Assoc Medicale Can. 2000;163(8):977-81.
17. Kiely D, Bergmann M, Murphy K, Jones R, Orav E, Marcantonio E. Delirium among newly admitted postacute facility patients: prevalence, symptoms, and severity. J Gerontol A Biol Sci Med Sci. 2003;58:M441-5.
18. McNicoll L, Pisani MA, Zhang Y, Ely EW, Siegel MD, Inouye SK. Delirium in the intensive care unit: occurrence and clinical course in older patients. J Am Geriatr Soc. 2003;51(5):591-8.
19. Lawlor PG, Gagnon B, Mancini IL, Pereira JL, Hanson J, Suarez-Almazor ME, et al. Occurrence, causes, and outcome of delirium in patients with advanced cancer: a prospective study. Arch Intern Med. 2000;160(6):786-94.
20. Rudolph JL, Marcantonio ER. Review articles: postoperative delirium: acute change with long-term implications. Anesth Analg. 2011;112(5):1202-11.
21. Tema NSZ, Janse Van Rensburg ABR. Psychiatric consultations and the management of associated comorbid medical conditions in a regional referral hospital. South Afr J Psychiatry. 2015;21(2):6.
22. van den Boogaard M, Peters SA, van der Hoeven JG, et al. The impact of delirium on the prediction of in-hospital mortality in intensive care patients. Crit Care. 2010;14(4):R146.
23. Salluh JI, Soares M, Teles JM, et al. Delirium epidemiology in critical care (DECCA): an international study. Crit Care. 2010;14(6):R210.
24. Pisani MA, Kong SY, Kasl SV, Murphy TE, Araujo KL, Van Ness PH. Days of delirium are associated with 1-year mortality in an older intensive care unit population. Am J Respir Crit Care Med. 2009;180(11):1092-7.
25. Girard TD, Jackson JC, Pandharipande PP, et al. Delirium as a predictor of long-term cognitive impairment in survivors of critical illness. Crit Care Med. 2010;38(7):1513-20.
26. Ely EW, Inouye SK, Bernard GR, et al. Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). JAMA. 2001;286(21):2703-10./
27. Dubois MJ, Bergeron N, Dumont M, Dial S, Skrobik Y. Delirium in an intensive care unit: a study of risk factors. Intensive Care Med. 2001;27(8):1297-1304.
28. McNicoll L, Pisani MA, Zhang Y, Ely EW, Siegel MD, Inouye SK. Delirium in the intensive care unit: occurrence and clinical course in older patients. J Am Geriatr Soc. 2003;51(5):591-8.
29. Pandharipande P, Shintani A, Peterson J, Pun BT, Wilkinson GR, Dittus RS, et al. Lorazepam is an independent risk factor for transitioning to delirium in intensive care unit patients. Anesthesiology. 2006;104(1):21-6.
30. Jackson JC, Gordon SM, Hart RP, Hopkins RO, Ely EW. The association between delirium and cognitive decline: a review of the empirical literature. Neuropsychol Rev. 2004;14(2):87-98.
31. Ní Chróinín D, Alexandrou E, Frost SA. Delirium in the intensive care unit and its importance in the post-operative context: a review. Front Med. 2023;10:1071854.
32. Mart MF, Williams Roberson S, Salas B, Pandharipande PP, Ely EW. Prevention and management of delirium in the intensive care unit. Semin Respir Crit Care Med. 2021;42(1):112-26.
33. Miranda F, Gonzalez F, Plana MN, Zamora J, Quinn TJ, Seron P. Confusion assessment method for the intensive care unit (CAM-ICU) for the diagnosis of delirium in adults in critical care settings. Cochrane Database Syst Rev. 2023;11(11):CD013126.
34. Bergeron N, Dubois MJ, Dumont M, Dial S, Skrobik Y. Intensive care delirium screening checklist: evaluation of a new screening tool. Intensive Care Med. 2001;27(5):859-64.
35. Elm E. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med. 2007;147:573.
36. Rahimi-Bashar F, Abolhasani G, Manouchehrian N, Jiryaee N, Vahedian-Azimi A, Sahebkar A. Incidence and Risk Factors of Delirium in the Intensive Care Unit: A Prospective Cohort. BioMed Res Int. 2021 Jan 8;2021:6219678.
37. Pan Y, Yan J, Jiang Z, Luo J, Zhang J, Yang K. Incidence, risk factors, and cumulative risk of delirium among ICU patients: acase-control study. Int J Nurs Sci. 2019;6(3):247-51.
38. Alzoubi E, Shaheen F, Yousef K. Delirium incidence, predictors and outcomes in the intensive care unit: a prospective cohort study. Int J Nurs Pract. 2023;30(1):e13154.
39. Jäckel M, Zotzmann V, Wengenmayer T, Duerschmied D, Biever PM, Spieler D, et al. Incidence and predictors of delirium on the intensive care unit after acute myocardial infarction, insight from a retrospective registry. Catheter Cardiovasc Interv. 2021;98(6):1072-81.
40. Ko Y, Kim HE, Park JY, Kim JJ, Cho J, Oh J. Relationship between body mass index and risk of delirium in an intensive care unit. Arch Gerontol Geriatr. 2023;108:104921.
41. Wood MD, Maslove DM, Muscedere JG, Day AG, Gordon Boyd J. Low brain tissue oxygenation contributes to the development of delirium in critically ill patients: a prospective observational study. J Crit Care. 2017;41:289-95.
42. Deschamps A, Hall R, Grocott H, Mazer CD, Choi PT, Turgeon AF, et al. Cerebral oximetry monitoring to maintain normal cerebral oxygen saturation during high-risk cardiac surgery. Anesthesiology. 2016;124(4):826-36.
43. Agarwal AK, Raja A, Brown BD. Chronic obstructive pulmonary disease. In: StatPearls. Treasure Island (FL): StatPearls Publishing; August 7, 2023.
44. Correale M, Altamura M, Carnevale R, Tricarico L, Malerba S, Gallotta AM, et al. Delirium in heart failure. Heart Fail Rev. 2020;25(5):713-23.
45. Niu Z, Zhou J, Li Y. Prognostic significance of delirium in patients with heart failure: a systematic review and meta-analysis. Front Cardiovasc Med. 2023;10:1217965.
46. Ibrahim K, McCarthy CP, McCarthy KJ, et al. Delirium in the cardiac intensive care unit. J Am Heart Assoc. 2018;7(4):e008568.
47. Ashine TM, Heliso AZ, Babore GO, Ezo E, Saliya SA, Birehanu Muluneh B, et al. Incidence and predictors of cardiac arrest among patients admitted to the intensive care units of a comprehensive specialized hospital in Central Ethiopia. Patient Relat Outcome Meas. 2023;15:31-43.
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How to Cite
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Habtamu A, Mezgebu T, Workina A, Lemma B, Tolessa feyissa, Getahun E, Wondimagegn A, Kelbessa A, Abebe F. Incidence and predictors of delirium among the intensive care unit patients at Jimma Medical Center, Southwest Ethiopia. Front Emerg Med. 2024;.
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