the impact of delirium on the prediction of in-hospital mortality in intensive care patients精神错乱的影响在重症监护患者的住院死亡率的预测.pdfVIP

van den Boogaard et al. Critical Care 2010, 14:R146 /content/14/4/R146 RESEARCH Open Access The impact of delirium on the prediction of in-hospital mortality in intensive care patients 1*† 2† 1 2 2 Mark van den Boogaard , Sanne AE Peters , Johannes G van der Hoeven , Pieter C Dagnelie , Pieter Leffers , 1 3 Peter Pickkers , Lisette Schoonhoven Abstract Introduction: Predictive models, such as acute physiology and chronic health evaluation II (APACHE-II), are widely used in intensive care units (ICUs) to estimate mortality. Although the presence of delirium is associated with a higher mortality in ICU patients, delirium is not part of the APACHE-II model. The aim of the current study was to evaluate whether delirium, present within 24 hours after ICU admission, improves the predictive value of the APACHE-II score. Methods: In a prospective cohort study 2116 adult patients admitted between February 2008 and February 2009 were screened for delirium with the confusion assessment method-ICU (CAM-ICU). Exclusion criteria were sustained coma and unable to understand Dutch. Logistic regression analysis was used to estimate the predicted probabilities in the model with and without delirium. Calibration plots and the Hosmer-Lemeshow test (HL-test) were used to assess calibration. The discriminatory power of the models was analyzed by the area under the receiver operating characteristics curve (AUC) and AUCs were compared using the Z-test. Results: 1740 patients met the inclusion criteria, of which 332 (19%) were delirious at the time of ICU admission or within 24 hours after admission. Delirium was associated with in-hospital mor