Incidence, risk factors, and clinical implications of post-operative delirium in lung transplant recipients

JOURNAL OF HEART AND LUNG TRANSPLANTATION

卷:37

Article

Anderson, Brian J.¹  Chesley, Christopher F.²  Theodore, Miranda¹  Christie, Colin¹  Tino, Ryan¹  Wysoczanski, Alex¹  Ramphal, Kristy¹  Oyster, Michelle¹  Kalman, Laurel¹  Porteous, Mary K.¹  Bermudez, Christian A.³  Cantu, Edward³  Kolson, Dennis L.⁴  Christie, Jason D.¹  Diamond, Joshua M.¹ 

[1] Univ Penn, Div Pulm Allergy & Crit Care Med, Philadelphia, PA 19104 USA

[2] Univ Penn, Dept Med, Philadelphia, PA 19104 USA

[3] Univ Penn, Div Cardiovasc Surg, Philadelphia, PA 19104 USA

[4] Univ Penn, Dept Neurol, Perelman Sch Med, Philadelphia, PA 19104 USA

关键词: lung transplantation;    delirium;    neuron-specific enolase;    glial fibrillary;    acidic protein;    primary graft dysfunction;    benzodiazepines;    postoperative complications;   

DOI  :  10.1016/j.healun.2018.01.1295

来源: Elsevier

【 摘 要 】

BACKGROUND: Delirium significantly affects post-operative outcomes, but the incidence, risk factors, and long-term impact of delirium in lung transplant recipients have not been well studied. METHODS: We analyzed 155 lung transplant recipients enrolled in the Lung Transplant Outcomes Group (LTOG) cohort at a single center. We determined delirium incidence by structured chart review, identified risk factors for delirium, determined whether plasma concentrations of 2 cerebral injury markers (neuron-specific enolase [NSE] and glial fibrillary acidic protein [GFAP]) were associated with delirium, and determined the association of post-operative delirium with 1-year survival. RESULTS: Fifty-seven (36.8%) patients developed post-operative delirium. Independent risk factors for delirium included pre-transplant benzodiazepine prescription (relative risk [RR] 1.82; 95% confidence interval [CI] 1.08 to 3.07; p = 0.025), total ischemic time (RR 1.10 per 30-minute increase; 95% CI 1.01 to 1.21; p = 0.027), duration of time with intra-operative mean arterial pressure <60 mm Hg (RR 1.07 per 15-minute increase; 95% CI 1.00 to 1.14; p = 0.041), and Grade 3 primary graft dysfunction (RR 2.13; 95% CI 1.27 to 3.58; p = 0.004). Ninety-one (58.7%) patients had plasma available at 24 hours. Plasma GFAP was inconsistently detected, whereas NSE was universally detectable, with higher NSE concentrations associated with delirium (risk difference 15.1% comparing 75th and 25th percentiles; 95% CI 2.5 to 27.7; p = 0.026). One-year mortality appeared higher among delirious patients, 12.3% compared with 7.1%, but the difference was not significant (p = 0.28). CONCLUSIONS: Post-operative delirium is common in lung transplant recipients, and several potentially modifiable risk factors deserve further study to determine their associated mechanisms and predictive values. (C) 2018 International Society for Heart and Lung Transplantation. All rights reserved.

【 授权许可】

Free