(287) Relationship Between Total Delirium Severity Score and Two-Year Mortality in Critically Ill Adults

Monday, January 22, 2024

11:30 AM – 12:30 PM MT

Location: Connections Central - RST 13

First Author(s)

Samreen Jawaid, MD, (she/her/hers)

MD
Indiana University

Co-Author(s)

HL

Heidi Lindroth, PhD, RN

Dr.
Mayo Clinic
Rochester, Minnesota, United States
Parth Savsani, MD, (he/him/his)

Indiana University School of Medicine
SM

Salwa Moiz, n/a

Research Specialist
Regenstrief Institute, Indiana University School of Medicine, Indianapolis, IN, USA
Indianapolis, Indiana, United States
RC

Rosalyn Chi, MD

Pulmonary and Critical care Fellow Physician
Indiana University, United States
AP

Anthony Perkins, MS

Biostatistician
Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, USA
Indianapolis, Indiana, United States
JM

Jared Meeker, DO.

Dr.
University of Illinois, College of Medicine, Illinois, Chicago.OSF Healthcare, Saint Francis Medical Center, Peoria, Chicago., United States
SW

Sophia Wang, MD.

Dr.
Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA., United States
SG

Sujuan Gao, PhD

Professor of Biostatistics & Health Data Science
Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, USA
Indianapolis, Indiana, United States
SK

Sikandar Khan, DO, MS

Assistant Professor of Medicine/Physician Scientist
Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
Indianapolis, Indiana, United States
BK

Babar Khan, MD

Professor of Medicine/Physician Scientist
Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
Indianapolis, Indiana, United States

Introduction: Prolonged duration and high severity of intensive care unit (ICU) delirium are individually associated with increased mortality. We combined ICU delirium duration and delirium severity into a novel composite Total Delirium Severity Score (TDS) and hypothesized that higher TDS scores would predict 2-year mortality with greater accuracy compared to mean delirium severity among critically ill adults.

Methods: This is a secondary analysis of data from 2 randomized-controlled trials. Richmond Agitation-Sedation Scale (RASS) and Confusion Assessment Method for ICU (CAM-ICU-7) assessed sedation/delirium twice daily from the day of ICU admission till hospital discharge or death. TDS was computed as sum of daily mean CAM-ICU-7 scores and split into tertiles. Mean delirium severity was calculated as the mean CAM-ICU-7 score and categorized into rapidly resolving (0-2), mild-moderate (2.1-5), and severe delirium (>5). Cox proportional hazard models and Kaplan-Meier survival curves assessed the relationship between each exposure measure and 2-year mortality. Area Under the Receiver Operating Curve (AUROC) and Spearman correlations were calculated. Sensitivity analysis assessed the relationship between subsyndromal delirium and mortality by treating all CAM-ICU-7 scores of < 2 as 0.

Results: 434 patients were included in the study with a mean age of 59.8 (SD 16.4) years, 54.6% were females and 48.6% were African American. The mean APACHE II score was 19.3 (SD 8.1). Both TDS and mean CAM-ICU-7 measures had an increased risk of 2-year mortality. Patients in the highest TDS tertile had significantly increased risk of 2-year mortality (aHR 1.7, 95% CI 1.1 2.6). Increasing mean delirium severity also increased risk of mortality (mild-moderate [aHR 1.1, 95% CI 0.7, 1.6] severe delirium [aHR 2.1, 95% CI 1.3, 3.4]). The AUROC for 2-year mortality risk was 0.72 for both measures. Both measures were moderately correlated (Spearman r=0.76, P< 0.001). TDS score lost association with 2-year mortality when subsyndromal delirium was excluded.

Conclusions: Highest mean delirium severity and highest TDS tertiles showed similar associations with 2-year mortality in critically ill patients. Future studies should delineate the relationship between duration of subsyndromal delirium and mortality.