Accuracy of delirium risk factors in adult intensive care unit patients

Cohort, prospective study with patients over 18 who had been hospitalized for over 24 hours and were able to communicate. The patients were assessed once a day until the onset of delirium or permanence in the Intensive Care Unit. Instruments were employed to track delirium, characterize the sample, and identify the risk factors. Descriptive statistics was employed for sample characterization and accuracy tests for risk factors.

Results:

The included patients amounted to 102, 31 of which presented delirium. The predisposing predictive risk factors were hypoalbuminemia, American Society of Anesthesiology over three, severity, altered tissue perfusion, dehydration, and being a male, whereas precipitating predictive factors were physical restraint, infection, pharmacological agent, polypharmacy, anemia, altered renal function, dehydration, invasive devices, altered tissue perfusion and altered quality and quantity of sleep.

Conclusion:

An accurate identification of predisposing and precipitating risk factors may contribute to planning preventive measures against delirium.

DESCRIPTORS
Delirium; Risk Factors; Hospitalization; Intensive Care Units; Data Accuracy

Variable	n (102)	%
Sex
Female	47	46.0
Male	55	54.0
Age
18 to 29 years	8	7.8
30 to 59 years	43	42.2
Over 60 years	51	50
Primary cause of hospitalization
Others	4	3.9
Abdominal	5	4.9
Renal	6	5.9
Respiratory	6	5.9
Trauma	13	12.7
Neurological	17	16.7
Cardiac	51	50.0
Type of treatment
Clinical	41	40.2
Surgical	61	59.8

RF*	SE^†	SP^‡	PPV^§	PPN^\|\|	^#LR+^$(CI)	⁺LR-^$(CI)	^##DOR^$(CI)
Hypoalbuminemia	1.00	0.36	0.58	1.00	1.58 (1.12; 2.23)	–	–
ASA > 3**	0.87	0.55	0.47	0.90	1.98 (1.47; 2.65)	0.22 (0.09; 0.57)	8.81 (2.79; 27.78)
Severity	0.81	0.64	0.50	0.88	2.28 (1.59; 3.25)	0.29 (0.14; 0.61)	7.80 (2.83; 21.49)
Altered tissue perfusion	0.75	0.40	0.36	0.77	1.25 (0.95; 1.65)	0.62 (0.32; 1.22)	2.00 (0.79; 5.08)
Dehydration	0.71	0.60	0.45	0.82	1.80 (1.25; 2.57)	0.47 (0.26; 0.84)	3.83 (1.55; 9.49)
Male	0.62	0.50	0.36	0.74	1.25 (0.88; 1.78)	0.75 (0.45; 1.24)	1.67 (0.71; 3.92)
Altered visual acuity	0.53	0.28	0.25	0.57	0.74 (0.52; 1.06)	1.64 (0.97; 2.77)	0.45 (0.19; 1.08)
Age > or equal to 60 years old	0.50	0.51	0.32	0.69	1.03 (0.67; 1.57)	0.97 (0.64; 1.47)	1.06 (0.46; 2.44)
Comorbidity	0.43	0.80	0.50	0.75	2.19 (1.19; 4.03)	0.70 (0.51; 0.98)	3.11 (1.25; 7.74)
Smoking	0.31	0.77	0.38	0.71	1.37 (0.70; 2.67)	0.89 (0.68; 1.16)	1.53 (0.60; 3.90)
Alcohol abuse	0.18	0.97	0.75	0.72	6.56 (1.40; 30.76)	0.84 (0.70; 0.99)	7.85 (1.49; 41.38)
Functional impairment	0.09	0.97	0.60	0.69	3.23 (0.57; 18.42)	0.93 (0.83; 1.05)	3.47 (0.55; 21.85)
History of delirium	0.03	0.94	0.20	0.68	0.55 (0.06; 4.70)	1.03 (0.94; 1.12)	0.53 (0.06; 4.96)

RF*	SE^†	SP^‡	PPV^§	PPN^\|\|	^#LR+^$(CI)	⁺LR-^$(CI)	^##DOR^$(CI)
Physical restraint	1.00	0.05	0.32	1.00	1.06 (1.00; 1.12)	–	–
Infection	0.96	0.37	0.41	0.96	1.55 (1.28; 1.89)	0.08 (0.01; 0.58)	18.74 (2.41; 145.6)
Pharmacological agent	0.96	0.05	0.31	0.80	1.03 (0.94; 1.12)	0.55 (0.06; 4.70)	1.88 (0.20; 17.52)
Polypharmacy	0.93	0.10	0.32	0.77	1.04 (0.93; 1.17)	0.62 (0.14; 2.84)	1.67 (0.33; 8.51)
Anemia	0.84	0.21	0.33	0.75	1.08 (0.89; 1.31)	0.72 (0.29; 1.81)	1.50 (0.49; 4.56)
Days of ICU	0.81	0.18	0.31	0.68	1.00 (0.82; 1.22)	1.01 (0.42; 2.42)	0.99 (0.34; 2.89)
Altered renal function	0.78	0.48	0.40	0.82	1.52 (1.13; 2.03)	0.45 (0.22; 0.90)	3.37 (1.29; 8.81)
Dehydration	0.71	0.60	0.45	0.82	1.80 (1.25; 2.57)	0.47 (0.26; 0.84)	3.83 (1.55; 9.49)
Invasive devices (>2)	0.75	0.87	0.72	0.88	5.83 (3.07; 11.08)	0.29 (0.16; 0.53)	20.33 (7.02; 58.87)
Altered tissue perfusion	0.75	0.40	0.36	0.77	1.25 (0.95; 1.65)	0.62 (0.32; 1.22)	2.00 (0.79; 5.08)
Altered quality and quantity of sleep	0.68	0.48	0.37	0.77	1.34 (0.96; 1.85)	0.64 (0.36; 1.13)	2.08 (0.86; 5.02)
Time of the anesthetic and surgical procedure	0.61	0.18	0.17	0.64	0.76 (0.48; 1.19)	2.05 (0.83; 5.07)	0.37 (0.10; 1.40)
Nutritional deficiency	0.46	0.52	0.31	0.68	0.99 (0.64; 1.55)	1.01 (0.68; 1.49)	0.99 (0.43; 2.29)
Mechanical ventilation	0.43	0.95	0.82	0.78	10.21 (3.15; 33.05)	0.59 (0.43; 0.80)	17.37 (4.50; 67.08)
Pain	0.28	0.77	0.36	0.70	1.23 (0.62; 2.48)	0.93 (0.72; 1.20)	1.32 (0.51; 3.42)
Blood transfusion	0.03	0.98	0.50	0.69	2.19 (0.14; 33.88)	0.98 (0.92; 1.05)	2.23 (0.13; 36.75)

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Corresponding author:
Luciana Aparecida Costa Carvalho Rua Hermano Penteado, 210 13060-800 – Campinas, SP, Brazil, luciana89.carvalho@gmail.com