Early-onset delirium after spontaneous intracerebral hemorrhage

医学 谵妄 脑出血 痴呆 内科学 入射(几何) 队列 置信区间 比例危险模型 队列研究 人口 麻醉 儿科 蛛网膜下腔出血 精神科 物理 光学 疾病 环境卫生
作者
Federico Marrama,Maéva Kyheng,Marco Pasi,Matthieu Pierre Rutgers,Solène Moulin,Marina Diomedi,Didier Leys,Charlotte Cordonnier,Hilde Hénon,Barbara Casolla
出处
期刊:International Journal of Stroke [SAGE Publishing]
卷期号:17 (9): 1030-1038 被引量:5
标识
DOI:10.1177/17474930211059636
摘要

Objective This study aimed at identifying the incidence, predictors, and impact on long-term mortality and dementia of early-onset delirium in a cohort of patients with spontaneous intracerebral hemorrhage. Methods We prospectively recruited consecutive patients in the Prognosis of InTra-Cerebral Hemorrhage (PITCH) cohort and analyzed incidence rate of early-onset delirium (i.e. during the first seven days after intracerebral hemorrhage onset) with a competing risk model. We used a multivariable Fine-Gray model to identify baseline predictors, a Cox regression model to study its impact on the long-term mortality risk, and a Fine-Gray model adjusted for pre-specified confounders to analyze its impact on new-onset dementia. Results The study population consisted of 248 patients (mean age 70 years, 54% males). Early-onset delirium incidence rate was 29.8% (95% confidence interval (CI) 24.3–35.6). Multivariate analysis showed that pre-existing dementia (subhazard ratio (SHR) 2.08, 95%CI 1.32–3.32, p = 0.002), heavy alcohol intake (SHR 1.79, 95%CI 1.13–2.82, p = 0.013), and intracerebral hemorrhage lobar location (SHR 1.56, 95%CI 1.01–2.42, p = 0.049) independently predicted early-onset delirium. Median follow-up was 9.5 years. Early-onset delirium was associated with higher mortality rates during the first five years of follow-up (HR 1.52, 95%CI 1.00–2.31, p = 0.049), but did not predict new-onset dementia (SHR 1.31, 95%CI 0.60–2.87). Conclusion Early-onset delirium is a frequent complication after intracerebral hemorrhage; it is associated with markers of pre-existing brain vulnerability and with higher mortality risk, but not with higher dementia rates during long-term follow-up.
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