Incidence and short term outcome of patients manifesting delirium in a university hospital cardiac intensive care unit

Among patients admitted in Intensive Care Unit, delirium is increasingly a common manifestation, especially on those who need mechanical ventilation. Due to its potential unfavorable effect on outcomes, early detection and adequate treatment may have an important preventive value.

To evaluate in-hospital and 30 days’ outcome of patients experiencing delirium in a Tertiary Center Cardiac Intensive Care Unit.

We prospectively collected in hospital and 30-day follow-up data of 113 consecutive patients admitted at our cardiac intensive care unit from May to December 2022, who manifested delirium. Primary endpoint was in-hospital and 30-day all-cause death. Secondary endpoints included major in-hospital adverse events (composite of new onset or decompensated heart failure, bleeding, malignant ventricular arrhythmia, and acute renal failure), and composite of re-hospitalization and reappearance of cognitive dysfunction at 30-day follow-up.

Out of 1952 patients admitted at our intensive care unit, 133 (5.79%) manifested delirium, with a rate of in-hospital all-cause mortality of 14.78% compared to 4.6% of total cohort. 30 days’ all-cause mortality for the studied population was 30.97%. New onset or worsening of heart failure occurred in 27.4% of patients, acute kidney injury in 27.4% of patients, malignant ventricular arrhythmias in 12.4% and major bleeding (BARC3, 5) in 5.3% of patients. During 30 days’ follow-up, the rate of re-hospitalization for cardiac causes was 9.4% and 33.3% of patients re-manifested cognitive dysfunction. Independent predictive factor for an in-hospital adverse event resulted the use of inotropic and vasopressor drugs and for occurrence of an adverse event at 30 days’ follow-up was history of atrial fibrillation and use of inotropic and vasopressor drugs.

Delirium among patients hospitalized in cardiac ICU is related with worse short term outcomes including higher rates of death from any cause. Early detection and appropriate treatment has a crucial importance in preventing major adverse events.