Assessment of risk factors and precipitating factors of delirium in patients admitted to intensive care unit of a tertiary care hospital

摘要

Background and Aim: Delirium is defined as disturbance in attention and awareness. Delirium is a common complication inpatients admiited to intensive care unit. The focus of the researchers has shifted from treatment to prevention of the syndrome. There isa need to study risk factors for prevention of delirium. Data on delirium in intensive care unit is scarce in the Indian subcontinent. Hence,the present study was done to assess risk factors and precipitating factors of delirium in patients admitted to medical intensive care unit ofa tertiary care hospital.Materials and Methods: This is an observational study done over a period of 1 year. Patients admitted to medical ICU were screened forpresence of delirium within first 72 hours of admission using RASS and CAM-ICU. Comatose patients, with RASS score of -4 or -5, wereexcluded from the study. Risk Factors and precipitating factors associated with delirium were assessed. Independent t-sample test or thePearson Chi-square test were used to calculate differences between delirious and non-delirious subjects. Odds ratios (OR) was calculatedfor all factors using univariate binary logistic regression.Results: Percentage of patients developing delirium within the first 72 hours of admission was 25.7% (406/1582). 52% of patients hadhypoactive delirium, 48% of them had hyperactive delirium. Alcohol (OR 6.54), sedatives usage at the time of admission (OR 2.48),visual disturbances (OR 2.22), bowel and bladder disturbances (OR 1.67) were significant modifiable risk factors contributing todelirium. Previous psychiatric illness (OR 3.73), previous cognition impairment (OR 2.73) were significant non-modifiable risk factorscontributing to delirium. Predominant precipitating factors among delirious subjects were uremia (25.1%), hepatic encephalopathy(22.7%), hyponatremia (19.5%).Conclusion: Delirium is common in intensive care unit patients. Major risk factor contributing to delirium was alcohol consumption.Most common precipitating factors resulting in delirium were deranged metabolic parameters. All ICUs should implement both RASSand CAM-ICU for early detection of delirium.