摘要
Abstract
Objective To analyze the risk factors for delirium in patients with subarachnoid hemorrhage(SAH)in the neurology intensive care unit and to construct a risk prediction model.
Methods A prospective cohort study design was used to include SAH patients continuously admitted to the neurology intensive care unit of Beijing Tiantan Hospital,Capital Medical University from January 1,2017,to January 1,2020.After admission,a unified standard protocol was used to collect demographic information,disease-related data,surgical treatment information,and other data.According to the results of the confusion assessment method for the intensive care unit(CAM-ICU),patients were divided into the delirium group and the non-delirium group.Differences in data between the two groups were compared.The independent risk factors were screened using multivariate logistic regression.A prediction model was constructed based on risk factors,and the diagnostic efficacy of the model was evaluated using the AUC and the Hosmer-Lemeshow(H-L)goodness of fit test.
Results A total of 252 SAH patients were included,and 42(16.7%)experienced delirium.The results of multivariate logistic regression analysis showed that drinking history(OR4.005,95%CI1.538-10.432,P<0.001),coronary artery heart disease history(OR6.758,95%CI2.048-22.301,P<0.001),mechanical ventilation(OR7.816,95%CI2.305-26.500,P<0.001),use of analgesics(OR2.832,95%CI1.093-7.334,P=0.032),use of sedatives(OR21.896,95%CI8.397-57.092,P<0.001),and hypoalbuminemia(OR3.047,95%CI1.121-8.282,P=0.029)were independent risk factors for delirium in patients with SAH in the neurology intensive care unit.The prediction model was Logit(P)=-4.553+1.388×drinking history+1.911×coronary artery heart disease history+2.056×mechanical ventilation+1.041×use of analgesics+3.086×use of sedatives+1.114×hypoalbuminemia.The AUC value of the model was 0.890(95%CI0.829-0.951,P<0.001).The Hosmer-Lemeshow test χ2=3.579,P=0.733.The maximum Youden index was 0.695,corresponding to a sensitivity of 76.2%,a specificity of 93.3%,and a prediction accuracy of 89.7%.
Conclusions Drinking history,coronary artery heart disease history,mechanical ventilation,use of analgesics,use of sedatives,and hypoalbuminemia are independent risk factors for delirium in patients with SAH in the neurology intensive care unit.The constructed prediction model based on the factors above has good performance.关键词
蛛网膜下腔出血/神经重症监护病房/谵妄/危险因素/预测模型Key words
Subarachnoid hemorrhage/Neurology intensive care unit/Delirium/Risk factor/Prediction model分类
医药卫生
