The relationship between the PRE-DELIRIC score and the prognosis in COVID-19 ICU patients
The PRE-DELIRIC score in COVID-19 ICU
Keywords:
delirium, critical care, COVID-19, mortality, PRE-DELIRIC scoreAbstract
Background/Aim: The PRE-DELIRIC score is a test to detect delirium in the intensive care unit (ICU). Delirium has been studied as a factor associated with the clinical course of patients in COVID-19 intensive care. Our study aimed to investigate the relationship between the PRE-DELIRIC score and prognosis in patients followed in the COVID-19 ICU.
Methods: Patients hospitalized in the COVID-19 ICU between March 2020 and May 2021 were retrospectively analyzed, and 461 patients were included in the study. The PRE-DELIRIC scores of the patients were calculated using data obtained from the hospital information system. Patients with a PRE-DELIRIC score ≥50 were considered Group 1, and those with a score <50 were considered Group 2. The groups were compared in terms of gender, Glasgow Coma Scale (GCS), Acute Physiology and Chronic Health Evaluation (APACHE II) score, Sequential Organ Failure Evaluation Score (SOFA), length of hospital stay, and mortality rates.
Results: Of the 461 patients included in the study, 153 were female, and 308 were male. A high PRE-DELIRIC score was determined in 157 (34.1%) patients (Group 1), while 304 patients (65.9%) had lower scores (Group 2). The hospitalization duration was 9.6 (6.7) days, and the mortality rate was 87.2% in Group 1, compared to 8.2 (6.03) days and 38.1% in Group 2, respectively. A significant difference was observed in the length of hospital stay and mortality between the groups (P<0.001). The rate of patients who were intubated and followed up on an invasive mechanical ventilator (MV) was 81.5% in Group 1, whereas it was 16.4% in Group 2 (P<0.001).
Conclusion: Our study found that patients with a high PRE-DELIRIC score indicating delirium had higher mortality rates and longer hospital and MV stays. Delirium is one of the factors affecting mortality in COVID-19 disease. We believe that the PRE-DELIRIC score, as one of these factors, can serve as an important prognostic test in COVID-19 ICU patients.
Downloads
References
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: APA Press; 2013. DOI: https://doi.org/10.1176/appi.books.9780890425596
Bellelli G, Morandi A, Di Santo SG, Mazzone A, Cherubini A, Mossello E, et al; Italian Study Group on Delirium (ISGoD). "Delirium Day”: a nationwide point prevalence study of delirium in older hospitalized patients using an easy standardized diagnostic tool. BMC Med. 2016;14:106. DOI: https://doi.org/10.1186/s12916-016-0649-8
Inouye SK. Delirium in older persons. N Engl J Med. 2006;354:1157-65. DOI: https://doi.org/10.1056/NEJMra052321
Seo Y, Lee HJ, Ha EJ, Ha TS. 2021 KSCCM clinical practice guidelines for pain, agitation, delirium, immobility, and sleep disturbance in the intensive care unit. Acute Crit Care. 2022;37(1):1-25. DOI: https://doi.org/10.4266/acc.2022.00094
Luz M, Brandão Barreto B, de Castro REV, Salluh J, Dal-Pizzol F, Araujo C, et al. Practices in sedation, analgesia, mobilization, delirium, and sleep deprivation in adult intensive care units (SAMDS-ICU):an international survey before and during the COVID-19 pandemic. Ann Intensive Care. 2022;4;12(1):9. DOI: https://doi.org/10.1186/s13613-022-00985-y
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;27:1297-304. DOI: https://doi.org/10.1007/s001340101017
Ko RE, Kang D, Park H, Cho J, Suh GY, Chung CR. Association between the presence of delirium during intensive care unit admission and cognitive impairment or psychiatric problems: the Korean ICU National Data Study. J Intensive Care. 2022;10(1):7. DOI: https://doi.org/10.1186/s40560-022-00598-4
Hashem MD, Nallagangula A, Nalamalapu S, Nunna K, Nausran U, Robinson KA, et al. Patient outcomes after critical illness: a systematic review of qualitative studies following hospital discharge. Crit Care. 2016;20(1):345. DOI: https://doi.org/10.1186/s13054-016-1516-x
Karnatovskaia LV, Johnson MM, Benzo RP, Gajic O. The spectrum of psy chocognitive morbidity in the critically ill: a review of the literature and call for improvement. J Crit Care. 2015;30(1):130-7. DOI: https://doi.org/10.1016/j.jcrc.2014.09.024
Helms J, Kremer S, Merdji H, Schenck M, Severac F, Clere-Jehl R, et al. Delirium and encephalopathy in severe COVID-19:a cohort analysis of ICU patients. Crit Care. 2020;24(1):491. DOI: https://doi.org/10.1186/s13054-020-03200-1
Ragheb J, McKinney A, Zierau M, Brooks J, Hill-Caruthers M, Iskander M, et al. Delirium and neuropsychological outcomes in critically Ill patients with COVID-19:a cohort study. BMJ Open. 2021;11(9):e050045.
van den Boogaard M, Pickkers P, Slooter AJ, Kuiper MA, Spronk PE, van der Voort PH, et al. Development and validation of PRE-DELIRIC (PREdiction of DELIRium in ICu patients) delirium prediction model for intensive care patients: observational multicentre study. BMJ. 2012;344:1-11. DOI: https://doi.org/10.1136/bmj.e420
van den Boogaard M, Schoonhoven L, Maseda E, Plowright C, Jones C, Luetz A, et al. Recalibration of the delirium prediction model for ICU patients (PRE-DELIRIC): a multinational observational study. Intensive Care Med. 2014;40:361-9. DOI: https://doi.org/10.1007/s00134-013-3202-7
Linkaitė G, Riauka M, Bunevičiūtė I, Vosylius S. Evaluation of PRE-DELIRIC (PREdiction of DELIRium in ICu patients) delirium prediction model for the patients in the intensive care unit. Acta Med Litu. 2018;25(1):14-22. DOI: https://doi.org/10.6001/actamedica.v25i1.3699
Zaal IJ, Devlin JW, Peelen LM, Slooter AJ. A systematic review of risk factors for delirium in the ICU. Crit Care Med. 2015;43(1):40-7. DOI: https://doi.org/10.1097/CCM.0000000000000625
Kim NY, Ryu SA, Kim YH. Factors Related to Delirium of Intensive Care Unit Patients in Korea: A Systematic Review. Iran J Public Health. 2021;50(8):1526-35. DOI: https://doi.org/10.18502/ijph.v50i8.6798
Krewulak KD, Stelfox HT, Leigh JP, Ely EW, Fiest KM. Incidence and prevalence of delirium subtypes in an adult ICU: a systematic review and meta-analysis. Crit Care Med. 2018;46(12):2029-35. DOI: https://doi.org/10.1097/CCM.0000000000003402
Palakshappa JA, Hough CL. How We Prevent and Treat Delirium in the ICU. Chest. 2021;1 60(4):1326-34. DOI: https://doi.org/10.1016/j.chest.2021.06.002
Ragheb J, McKinney A, Zierau M, Brooks J, Hill-Caruthers M, Iskander M, et al. Delirium and neuropsychological outcomes in critically Ill patients with COVID-19: a cohort study. BMJ Open. 2021;11(9):e050045. DOI: https://doi.org/10.1136/bmjopen-2021-050045
Liu K, Nakamura K, Katsukawa H, Elhadi M, Nydahl P, Ely EW, et al. ABCDEF Bundle and Supportive ICU Practices for Patients With Coronavirus Disease 2019 Infection: An International Point Prevalence Study. Crit Care Explor. 2021;3(3):e0353. DOI: https://doi.org/10.1097/CCE.0000000000000353
Devlin JW, O'Neal HR Jr, Thomas C, Barnes Daly MA, Stollings JL, Janz DR, et al. Strategies to Optimize ICU Liberation (A to F) Bundle Performance in Critically Ill Adults With Coronavirus Disease 2019. Crit Care Explor. 2020;2(6):e0139. DOI: https://doi.org/10.1097/CCE.0000000000000139
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. DOI: https://doi.org/10.1001/jama.2010.1013
Peterson JF, Pun BT, Dittus RS, Thomason JW, Jackson JC, Shintani AK, et al. Delirium and its motoric subtypes: a study of 614 critically ill patients. J Am Geriatr Soc. 2006;54:479-84. DOI: https://doi.org/10.1111/j.1532-5415.2005.00621.x
Kyziridis TC. Post-operative delirium after hip fracture treatment: a review of the current literature. GMS Psycho-Social Medicine. 2006;3:1-12.
Noımark D. Predicting the onset of delirium in the postoperative patient. Age Ageing. 2009;38:368-73. DOI: https://doi.org/10.1093/ageing/afp024
Mehta S, Cook D, Devlin JW, Skrobik Y, Meade M, Fergusson D, et al. SLEAP Investigators; Canadian Critical Care Trials Group. Prevalence, risk factors, and outcomes of delirium in mechanically ventilated adults. Crit Care Med. 2015;43(3):557-66. DOI: https://doi.org/10.1097/CCM.0000000000000727
Bulut NS, Yorguner N. Analysis of the psychiatric consultations requested for hospitalized COVID-19 patients: One year results from a major pandemic hospital. J Surg Med. 2022;6(3):322-30. DOI: https://doi.org/10.28982/josam.1083404
İnal MT, Memiş D, İnal V, Uyar AŞ, Tek ŞÇ, Çiftçi T, et al. Yoğun Bakım Hastalarında Pre-Deliryum Skorunun Değerlendirilmesi. J Turk Soc Intensive Care. 2018;16:26-9. DOI: https://doi.org/10.4274/tybd.85047
Downloads
- 152 281
Published
Issue
Section
How to Cite
License
Copyright (c) 2023 Bilge Banu Taşdemir Mecit
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.