本文由小咖机器人翻译整理

期刊来源：BMJ

原文链接：https://doi.org/10.1136/bmj-2023-077634

摘要内容如下：

目标

确定基线时无痴呆的老年患者群体中谵妄与痴呆事件之间关联的强度和性质。

设计

使用大规模医院管理数据的回顾性队列研究。

设置

2001年7月至2020年3月澳大利亚新南威尔士州的公立和私立医院。

参与者

从650590名年龄≥65岁的住院患者中提取数据。根据ICD-10（国际疾病分类，第10版）编码确定痴呆和谵妄的诊断。排除基线时患有痴呆的患者。通过匹配个人和临床特征来确定谵妄-无谵妄对，并随访5年以上。

主要结果指标

Cox比例风险模型和精细灰色风险模型分别用于评估谵妄与死亡和痴呆事件的相关性。对谵妄-结果-剂量-反应相关性进行量化，分别对男性和女性进行所有分析，并进行敏感性分析。

结果

该研究包括55211对配对（48%为男性，平均年龄83.4岁，标准差6.5岁）。总体而言，在5.25年的随访期间，58%（n=63929）的患者死亡，17%（n=19117）有新报告的痴呆诊断。与无谵妄的患者相比，谵妄患者的死亡风险高39%（危害比1.39，95%可信区间1.37-1.41），发生痴呆的风险高3倍（亚分布危害比3.00，95%可信区间2.91-3.10）。男性与痴呆的相关性更强（P=0.004）。每增加一次谵妄发作，痴呆风险增加20%（亚分布风险比为1.20，95%置信区间为1.18-1.23）。

结论

研究结果表明，在老年患者中，谵妄是死亡和痴呆事件的一个重要危险因素。数据支持谵妄和痴呆之间联系的因果解释。谵妄作为痴呆的一个潜在的可改变的危险因素，其临床意义是巨大的。

英文原文如下：

Abstracts

OBJECTIVES  To determine the strength and nature of the association between delirium and incident dementia in a population of older adult patients without dementia at baseline.

DESIGN  Retrospective cohort study using large scale hospital administrative data.

SETTING  Public and private hospitals in New South Wales, Australia between July 2001 and March 2020.

PARTICIPANTS  Data were extracted for 650 590 hospital patients aged ≥65 years. Diagnoses of dementia and delirium were identified from ICD-10 (international classification of diseases, 10th revision) codes. Patients with dementia at baseline were excluded. Delirium-no delirium pairs were identified by matching personal and clinical characteristics, and were followed for more than five years.

MAIN OUTCOME MEASURES  Cox proportional hazards models and Fine-Gray hazard models were used to estimate the associations of delirium with death and incident dementia, respectively. Delirium-outcome dose-response associations were quantified, all analyses were performed in men and women separately, and sensitivity analyses were conducted.

RESULTS  The study included 55 211 matched pairs (48% men, mean age 83.4 years, standard deviation 6.5 years). Collectively, 58% (n=63 929) of patients died and 17% (n=19 117) had a newly reported dementia diagnosis during 5.25 years of follow-up. Patients with delirium had 39% higher risk of death (hazard ratio 1.39, 95% confidence interval 1.37 to 1.41) and three times higher risk of incident dementia (subdistribution hazard ratio 3.00, 95% confidence interval 2.91 to 3.10) than patients without delirium. The association with dementia was stronger in men (P=0.004). Each additional episode of delirium was associated with a 20% increased risk of dementia (subdistribution hazard ratio 1.20, 95% confidence interval 1.18 to 1.23).

CONCLUSIONS  The study findings suggest delirium was a strong risk factor for death and incident dementia among older adult patients. The data support a causal interpretation of the association between delirium and dementia. The clinical implications of delirium as a potentially modifiable risk factor for dementia are substantial.

-----------分割线---------

点击链接：https://www.mediecogroup.com/community/user/vip/categories/ ，成为医咖会员，获取12项专属权益。