Risk factors for delirium among hospitalized patients in Zambia.

Journal: PloS one

Volume: 16

Issue: 4

Year of Publication: 2021

Affiliated Institutions:  Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, United States of America. University of Zambia School of Medicine, Lusaka, Zambia. Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America. Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America. Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America.

Abstract summary 

To identify risk factors for delirium among hospitalized patients in Zambia.We conducted a prospective cohort study at the University Teaching Hospital in Lusaka, Zambia, from October 2017 to April 2018. We report associations of exposures including sociodemographic and clinical factors with delirium over the first three days of hospital admission, assessed using a modified Brief Confusion Assessment Method (bCAM).749 patients were included for analysis (mean age, 42.9 years; 64.8% men; 47.3% with HIV). In individual regression analyses of potential delirium risk factors adjusted for age, sex and education, factors significantly associated with delirium included being divorced/widowed (OR 1.64, 95% CI 1.09-2.47), lowest tercile income (OR 1.58, 95% CI 1.04-2.40), informal employment (OR 1.97, 95% CI 1.25-3.15), untreated HIV infection (OR 2.18, 95% CI 1.21-4.06), unknown HIV status (OR 2.90, 95% CI 1.47-6.16), history of stroke (OR 2.70, 95% CI 1.15-7.19), depression/anxiety (OR 1.52, 95% CI 1.08-2.14), alcohol overuse (OR 1.96, 95% CI 1.39-2.79), sedatives ordered on admission (OR 3.77, 95% CI 1.70-9.54), severity of illness (OR 2.00, 95% CI 1.82-2.22), neurological (OR 7.66, 95% CI 4.90-12.24) and pulmonary-system admission diagnoses (OR 1.91, 95% CI 1.29-2.85), and sepsis (OR 2.44, 95% CI 1.51-4.08). After combining significant risk factors into a multivariable regression analysis, severity of illness, history of stroke, and being divorced/widowed remained predictive of delirium (p<0.05).Among hospitalized adults at a national referral hospital in Zambia, severity of illness, history of stroke, and being divorced/widowed were independently predictive of delirium. Extension of this work will inform future efforts to prevent, detect, and manage delirium in low- and middle-income countries.

Authors & Co-authors:  Banerdt Justin K JK Mateyo Kondwelani K Yan Yan Y Liu Dandan D Zuo Yi Y Di Gravio Chiara C Thome Julia C JC Riviello Elisabeth D ED Saylor Deanna D Ely E Wesley EW Heimburger Douglas C DC

Study Outcome 

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Statistics
Citations :  Vasilevskis EE, Han JH, Hughes CG, Ely EW. Epidemiology and risk factors for delirium across hospital settings. Best Pract Res Clin Anaesthesiol. 2012;26(3):277–87. 10.1016/j.bpa.2012.07.003
Authors :  11
Identifiers
Doi : e0249097
SSN : 1932-6203
Study Population
Male,Female
Mesh Terms
Adult
Other Terms
Study Design
Cohort Study
Study Approach
Country of Study
Zambia
Publication Country
United States