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      Key components of the delirium syndrome and mortality: greater impact of acute change and disorganised thinking in a prospective cohort study

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          Abstract

          Background: Delirium increases the risk of mortality during an acute hospital admission. Full syndromal delirium (FSD) is associated with greatest risk and subsyndromal delirium (SSD) is associated with intermediate risk, compared to patients with no delirium, suggesting a dose-response relationship. It is not clear how individual diagnostic symptoms of delirium influence the association with mortality. Our objectives were to measure the prevalence of FSD and SSD, and assess the effect that FSD, SSD and individual symptoms of delirium (from the Confusion Assessment Method-short version (s-CAM)) have on mortality rates. Methods: Exploratory analysis of a prospective cohort (aged 70 years and over) with acute (unplanned) medical admission (4/6/2007 to 4/11/2007). The outcome was mortality (data censored 6/10/2011). The principal exposures were FSD and SSD compared to no delirium (as measured by the CAM), along with individual delirium symptoms on the CAM. Cox regression was used to estimate the impact FSD and SSD and individual CAM items had on mortality. Results: The cohort (n=610) mean age was 83 (SD 7); 59% were female. On admission, 11% had FSD and 33% had SSD. Of the key diagnostic symptoms for delirium, 17% acute onset, 19% inattention, 17% disorganised thinking and 17% altered level of consciousness. Unadjusted analysis found FSD had an increased hazard ratio (HR) of 2.31 (95%CI 1.71 , 3.12), for SSD the HR was 1.26 (1.00 , 1.59). Adjusted analysis remained significant for FSD (1.55 95%CI 1.10 , 2.18) but nonsignificant for SSD (HR=0.92 95% CI 0.70 , 1.19). Two CAM items were significantly associated with mortality following adjustment: acute onset and disorganised thinking. Conclusion: We observed a dose-response relationship between mortality and delirium, FSD had the greatest risk and SSD having intermediate risk. The CAM items 'acute onset' and 'disorganised thinking' drove the associations observed. Clinically, this highlights the necessity of identifying individual symptoms of delirium.

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          Author and article information

          Journal
          bioRxiv
          January 22 2018
          Article
          10.1101/251272
          52cd0812-1c53-4f5c-9d60-a5314c0c812c
          © 2018
          History

          Evolutionary Biology,Medicine
          Evolutionary Biology, Medicine

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