Incidence, Risk Factors, and Sequelae of Post-kidney Transplant Delirium
Frail kidney transplant (KT) recipients may be particularly vulnerable to surgical stressors, resulting in delirium and subsequent adverse outcomes. We sought to identify the incidence, risk factors, and sequelae of post-KT delirium. We studied 125,304 adult KT recipients (1999-2014) to estimate del...
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| Vydáno v: | Journal of the American Society of Nephrology Ročník 29; číslo 6; s. 1752 |
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| Médium: | Journal Article |
| Jazyk: | angličtina |
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01.06.2018
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| ISSN: | 1533-3450, 1533-3450 |
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| Abstract | Frail kidney transplant (KT) recipients may be particularly vulnerable to surgical stressors, resulting in delirium and subsequent adverse outcomes. We sought to identify the incidence, risk factors, and sequelae of post-KT delirium.
We studied 125,304 adult KT recipients (1999-2014) to estimate delirium incidence in national registry claims. Additionally, we used a validated chart abstraction algorithm to identify post-KT delirium in 893 adult recipients (2009-2017) from a cohort study of frailty. Delirium sequelae were identified using adjusted logistic regression (length of stay ≥2 weeks and institutional discharge [skilled nursing or rehabilitation facility]) and adjusted Cox regression (death-censored graft loss and mortality).
Only 0.8% of KT recipients had a delirium claim. In the cohort study, delirium incidence increased with age (18-49 years old: 2.0%; 50-64 years old: 4.6%; 65-75 years old: 9.2%; and ≥75 years old: 13.8%) and frailty (9.0% versus 3.9%); 20.0% of frail recipients aged ≥75 years old experienced delirium. Frailty was independently associated with delirium (odds ratio [OR], 2.05; 95% confidence interval [95% CI], 1.02 to 4.13;
=0.04), but premorbid global cognitive function was not. Recipients with delirium had increased risks of ≥2-week length of stay (OR, 5.42; 95% CI, 2.76 to 10.66;
<0.001), institutional discharge (OR, 22.41; 95% CI, 7.85 to 63.98;
<0.001), graft loss (hazard ratio [HR], 2.73; 95% CI, 1.14 to 6.53;
=0.03), and mortality (HR, 3.12; 95% CI, 1.76 to 5.54;
<0.001).
Post-KT delirium is a strong risk factor for subsequent adverse outcomes, yet it is a clinical entity that is often missed. |
|---|---|
| AbstractList | Frail kidney transplant (KT) recipients may be particularly vulnerable to surgical stressors, resulting in delirium and subsequent adverse outcomes. We sought to identify the incidence, risk factors, and sequelae of post-KT delirium.
We studied 125,304 adult KT recipients (1999-2014) to estimate delirium incidence in national registry claims. Additionally, we used a validated chart abstraction algorithm to identify post-KT delirium in 893 adult recipients (2009-2017) from a cohort study of frailty. Delirium sequelae were identified using adjusted logistic regression (length of stay ≥2 weeks and institutional discharge [skilled nursing or rehabilitation facility]) and adjusted Cox regression (death-censored graft loss and mortality).
Only 0.8% of KT recipients had a delirium claim. In the cohort study, delirium incidence increased with age (18-49 years old: 2.0%; 50-64 years old: 4.6%; 65-75 years old: 9.2%; and ≥75 years old: 13.8%) and frailty (9.0% versus 3.9%); 20.0% of frail recipients aged ≥75 years old experienced delirium. Frailty was independently associated with delirium (odds ratio [OR], 2.05; 95% confidence interval [95% CI], 1.02 to 4.13;
=0.04), but premorbid global cognitive function was not. Recipients with delirium had increased risks of ≥2-week length of stay (OR, 5.42; 95% CI, 2.76 to 10.66;
<0.001), institutional discharge (OR, 22.41; 95% CI, 7.85 to 63.98;
<0.001), graft loss (hazard ratio [HR], 2.73; 95% CI, 1.14 to 6.53;
=0.03), and mortality (HR, 3.12; 95% CI, 1.76 to 5.54;
<0.001).
Post-KT delirium is a strong risk factor for subsequent adverse outcomes, yet it is a clinical entity that is often missed. Background Frail kidney transplant (KT) recipients may be particularly vulnerable to surgical stressors, resulting in delirium and subsequent adverse outcomes. We sought to identify the incidence, risk factors, and sequelae of post-KT delirium.Methods We studied 125,304 adult KT recipients (1999-2014) to estimate delirium incidence in national registry claims. Additionally, we used a validated chart abstraction algorithm to identify post-KT delirium in 893 adult recipients (2009-2017) from a cohort study of frailty. Delirium sequelae were identified using adjusted logistic regression (length of stay ≥2 weeks and institutional discharge [skilled nursing or rehabilitation facility]) and adjusted Cox regression (death-censored graft loss and mortality).Results Only 0.8% of KT recipients had a delirium claim. In the cohort study, delirium incidence increased with age (18-49 years old: 2.0%; 50-64 years old: 4.6%; 65-75 years old: 9.2%; and ≥75 years old: 13.8%) and frailty (9.0% versus 3.9%); 20.0% of frail recipients aged ≥75 years old experienced delirium. Frailty was independently associated with delirium (odds ratio [OR], 2.05; 95% confidence interval [95% CI], 1.02 to 4.13; P=0.04), but premorbid global cognitive function was not. Recipients with delirium had increased risks of ≥2-week length of stay (OR, 5.42; 95% CI, 2.76 to 10.66; P<0.001), institutional discharge (OR, 22.41; 95% CI, 7.85 to 63.98; P<0.001), graft loss (hazard ratio [HR], 2.73; 95% CI, 1.14 to 6.53; P=0.03), and mortality (HR, 3.12; 95% CI, 1.76 to 5.54; P<0.001).Conclusions Post-KT delirium is a strong risk factor for subsequent adverse outcomes, yet it is a clinical entity that is often missed.Background Frail kidney transplant (KT) recipients may be particularly vulnerable to surgical stressors, resulting in delirium and subsequent adverse outcomes. We sought to identify the incidence, risk factors, and sequelae of post-KT delirium.Methods We studied 125,304 adult KT recipients (1999-2014) to estimate delirium incidence in national registry claims. Additionally, we used a validated chart abstraction algorithm to identify post-KT delirium in 893 adult recipients (2009-2017) from a cohort study of frailty. Delirium sequelae were identified using adjusted logistic regression (length of stay ≥2 weeks and institutional discharge [skilled nursing or rehabilitation facility]) and adjusted Cox regression (death-censored graft loss and mortality).Results Only 0.8% of KT recipients had a delirium claim. In the cohort study, delirium incidence increased with age (18-49 years old: 2.0%; 50-64 years old: 4.6%; 65-75 years old: 9.2%; and ≥75 years old: 13.8%) and frailty (9.0% versus 3.9%); 20.0% of frail recipients aged ≥75 years old experienced delirium. Frailty was independently associated with delirium (odds ratio [OR], 2.05; 95% confidence interval [95% CI], 1.02 to 4.13; P=0.04), but premorbid global cognitive function was not. Recipients with delirium had increased risks of ≥2-week length of stay (OR, 5.42; 95% CI, 2.76 to 10.66; P<0.001), institutional discharge (OR, 22.41; 95% CI, 7.85 to 63.98; P<0.001), graft loss (hazard ratio [HR], 2.73; 95% CI, 1.14 to 6.53; P=0.03), and mortality (HR, 3.12; 95% CI, 1.76 to 5.54; P<0.001).Conclusions Post-KT delirium is a strong risk factor for subsequent adverse outcomes, yet it is a clinical entity that is often missed. |
| Author | Brown, 4th, Charles H Neufeld, Karin J Carlson, Michelle C Mountford, Alexandra Bae, Sunjae Berkowitz, Rachel Thomas, Alvin Haugen, Christine E Brennan, Daniel C McAdams-DeMarco, Mara Warsame, Fatima Segev, Dorry L |
| Author_xml | – sequence: 1 givenname: Christine E surname: Haugen fullname: Haugen, Christine E organization: Departments of Surgery – sequence: 2 givenname: Alexandra surname: Mountford fullname: Mountford, Alexandra organization: Departments of Surgery – sequence: 3 givenname: Fatima surname: Warsame fullname: Warsame, Fatima organization: Departments of Surgery – sequence: 4 givenname: Rachel surname: Berkowitz fullname: Berkowitz, Rachel organization: Departments of Surgery – sequence: 5 givenname: Sunjae surname: Bae fullname: Bae, Sunjae organization: Departments of Epidemiology and – sequence: 6 givenname: Alvin orcidid: 0000-0003-4911-8192 surname: Thomas fullname: Thomas, Alvin organization: Departments of Surgery – sequence: 7 givenname: Charles H surname: Brown, 4th fullname: Brown, 4th, Charles H organization: Anesthesiology and Critical Care Medicine – sequence: 8 givenname: Daniel C surname: Brennan fullname: Brennan, Daniel C organization: Medicine, and – sequence: 9 givenname: Karin J surname: Neufeld fullname: Neufeld, Karin J organization: Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland – sequence: 10 givenname: Michelle C surname: Carlson fullname: Carlson, Michelle C organization: Johns Hopkins University Center on Aging and Health, Baltimore, Maryland – sequence: 11 givenname: Dorry L orcidid: 0000-0002-1924-4801 surname: Segev fullname: Segev, Dorry L organization: Departments of Epidemiology and – sequence: 12 givenname: Mara orcidid: 0000-0003-3013-925X surname: McAdams-DeMarco fullname: McAdams-DeMarco, Mara email: mara@jhu.edu organization: Departments of Epidemiology and |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/29685884$$D View this record in MEDLINE/PubMed |
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| Keywords | epidemiology clinical geriatric nephrology transplant outcomes kidney transplantation |
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| Snippet | Frail kidney transplant (KT) recipients may be particularly vulnerable to surgical stressors, resulting in delirium and subsequent adverse outcomes. We sought... Background Frail kidney transplant (KT) recipients may be particularly vulnerable to surgical stressors, resulting in delirium and subsequent adverse outcomes.... |
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| SubjectTerms | Adolescent Adult Age Factors Aged Aged, 80 and over Cognition Delirium - epidemiology Delirium - etiology Frailty - epidemiology Graft Survival Humans Incidence Kidney Transplantation - adverse effects Kidney Transplantation - mortality Length of Stay - statistics & numerical data Longitudinal Studies Middle Aged Patient Discharge - statistics & numerical data Postoperative Complications - epidemiology Postoperative Complications - etiology Rehabilitation Centers - statistics & numerical data Risk Factors Skilled Nursing Facilities - statistics & numerical data United States - epidemiology Young Adult |
| Title | Incidence, Risk Factors, and Sequelae of Post-kidney Transplant Delirium |
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