Table 2.
Select cohort studies of post-transplant delirium in solid organ transplantation published within the past two decades (2000–2020).
| Organ | Reference | Demographics | % with and Measures of Delirium | Findings Associated with Post-Transplant Delirium | |
|---|---|---|---|---|---|
| Pre-Transplant Risk Factors | Post-Transplant Outcomes | ||||
| Liver | Yoon et al. (2009) | N=368 Mean Age: % female |
40% developed delirium (chart review) | History of alcohol consumption (OR=2.04; 95% CI: 1.12,3.72) History of hepatic encephalopathy (OR=2.54; 95% CI: 1.46,4.41) MELD score (OR= 1.03; 95% CI: 1.00,1.06) |
n/a |
| Lescot et al. (2013) | N=281 Mean Age: 58 29.5% female |
10% physician diagnosis based on DSM IV criteria | Intraoperative transfusion (packed RBC) (OR=1.15, 95%CI: 1.01, 1.18) Pretransplant renal replacement therapy (OR=13.12, 95%CI: 2.82, 72.12) APACHE II score (OR per unit increase=1.10, 95%CI: 1.03, 1.29) |
Longer hospital LOS (HR=2.37, 95%CI: 1.54, 3.85) In-hospital mortality (HR=4.30 95%CI: 1.62, 10.34) One-year mortality (HR=2.90, 95%CI: 1.29, 5.91) |
|
| Wang et al. (2014) | N=78 Mean Age: 53.4 25.6% female |
47% Richmond Agitation-Sedation Scale (RASS) and CAM-ICU | History of alcohol abuse (OR=6.40, 95%CI: 1.85, 22.06) Preoperative hepatic encephalopathy (OR = 4.45, 95% CI: 1.36,14.51) APACHE II score ≥16 (OR= 1.73, 95% CI: 1.71,2.56) Intubation duration ≥5 days (OR= 1.81, 95% CI: 1.52,2.23) |
Longer LOS in ICU (39.8 vs. 29.3; p=0.03) |
|
| Beckmann et al. (2016) | N=42 Mean Age: 55 31% female |
45% developed delirium with median duration of 5 days (Care Delirium Screening Checklist and Delirium Observation Screening Scale | n/a | Longer ICU stay (8 vs. 2 days, p<0.001) Longer hospital stays (32 vs. 14 days, p<0.001) Shorter survival (585 vs. 742 days, Breslow test p=0.046) |
|
| Oliver et al. (2017) | N= 181 Mean Age: 57–58 66.9% female |
21% developed delirium (EMR chart-abstractions) | Antidepressant use (OR=3.34, 95%CI: 1.29,8.70) Hospital admission for encephalopathy (OR=4.39, 95%CI: 1.77,10.9) |
Longer time on mechanical ventilation (2.0 vs. 1.3 days, p=0.01) Longer LOS in ICU (4.6 vs. 2.7 days, p=0.01) Longer hospital LOS (27.6 vs. 11.2 days, p=0.003). Higher 6-month mortality (13.2% vs. 1.4%, p=0.003) |
|
| Bhattacharya et al. (2017) | N=144 Mean Age: 51.8 33.3% female |
25% developed delirium, average duration 4.65 days (screened retrospectively using Delirium Observation Screening scale 8) | Older age (56.7 vs. 50.1; p=0.01) Increased MELD score (26.8 vs. 20.8; p=0.02) Longer pretransplant hospital LOS (20.9 vs. 6.4; p=0.003) Alcohol ingestion as cause of liver failure (33.3% vs. 16.7%; p=0.03) |
Longer hospital LOS (27.6 vs. 14.4 days; p=0.001) Longer ICU LOS (9.5 vs. 4.5 days; p=0.001) |
|
| Lee et al. (2018) | N=253 Median Age: 54 29.6% female |
17% developed delirium (CAM-ICU) | Higher preoperative MELD group (15–24vs.<15: OR=4.10, 95%CI: 1.67,10.09, ≥25vs.<15: OR=5.59, 95%CI: 2.06, 15.19) Higher APACHE II scores (OR=5.59, 95%CI: 2.06, 15.19) Reintubation (OR=6.46, 95%CI: 2.10, 19.88) |
Mechanical ventilation duration (10 vs. 5 hours; p=0.04) ICU LOS (5.8 vs. 4.1 days; p=0.004) Hospital LOS (38 vs. 21 days; p=0.004) No difference in 1-year mortality (p=0.06) |
|
| Chen et al. (2020) | N=159 Mean Age: 48 15.7% female |
26% developed delirium (CAM-ICU) | Preoperative ammonia (≥46 vs <46 μmol/L: OR=3.51, 95%CI:1.31,9.46) MELD score (≥15 vs.<15; OR=3.33, 95%CI: 1.27, 8.79) Presence of hepatic encephalopathy (OR=3.30, 95% CI: 1.20, 9.07) AST on day 1 postoperatively (OR=1.33, 95%CI: 1.06, 1.68) Anhepatic period (OR=1.04, 95%CI: 1.02, 1.06) |
Longer intubation time (2925.0 vs 1410.0 min, P<0.01), ICU LOS (6 vs 4 days, P<0.01) Increased medical costs (43.96 vs 33.74 ten thousand yuan, p<0.01) |
|
| Park et al. (2020) | N=325 Mean age: 53.4 72.3% female |
21% developed delirium (retrospective chart review) | Preoperative bilirubin<3.5 (OR=2.86, 95%CI: 1.38, 5.94) Body mass index (OR=0.85, 0.77, 0.94) Alcoholic Liver Disease (OR=1.63, 0.85, 3.13) Diuretic use (OR=2.18, 95%CI: 1.11, 4.30) Preoperative Creatinine (OR=1.50, 95%CI: 1.10, 2.06) |
n/a | |
| Kidney | Haugen et al. (2018) | N=893 Mean Age: 52.5 39.0% female |
4.7% developed delirium; 19% hypoactive, 16.7% hyperactive; 27% mixed type (chart abstraction) | Older age (OR=2.65, 95%CI: 1.36, 5.18) Multimorbidity (OR=1.93, 95%CI: 1.01, 3.71) Frailty (OR=2.05, 95%CI: 1.02, 4.13) |
≥2 week LOS (OR=5.42, 95%CI: 2.76, 10.66) Institutional discharge (OR=22.41, 95%CI: 7.85, 63.98) Graft loss (HR=2.73, 95%CI: 1.14, 6.53) Mortality (HR=3.12, 95%CI: 1.76, 5.54) |
| Lung | Smith et al. (2015) | N=63 Mean Age: 52.7 65% female |
37% developed delirium (CAM and DRS-R-98) | Better pre-transplant cognitive performance associated with reduced delirium incidence (OR=0.69, 95%CI: 0.48, 0.99) | Longer hospital LOS (p=0.01) |
| Smith et al. (2016) | N=63 Mean Age: 52.7 65% female |
37% developed delirium (CAM and DRS-R-98) | Lower cerebral perfusion pressure associated with: 1) developing delirium: (OR=2.08 per 10mmHG decrease, 95%CI: 1.02, 4.24) 2) delirium duration: (OR=1.7 days longer per 10mmHG decrease, 95%CI: 1.1–2.7); and 3) greater delirium severity (difference=−0.81, 95%CI: −1.47, −0.15) |
Primary graft dysfunction grade 0/1, 2 or 3 associated with delirium development (OR=3.38, 95%CI: 1.34, 8.56) Longer time in ICU associated with delirium duration (difference=0.51 days, 95%CI: 0.06, 0.95) & delirium severity (difference=0.90, 95%CI: 0.31, 1.49) |
|
| Sher et al. (2017) | N=163 Mean Age: 50.8 41.7% female |
44% developed delirium within 30 days post-transplant (EMR chart-abstractions) | Obesity (OR=6.35, 95%CI: 1.61–24.98) | Early-onset delirium was associated with: longer mechanical ventilation duration (p=0.001); ICU LOS (p<0.001), and hospital LOS (p=0.005). Ever-onset delirium was associated with longer ICU (p<0.001) and hospital LOS (p<0.001). Delirium was not associated with one-year mortality (early-onset HR 1.65, 95% CI 0.67–4.03; ever-onset HR 1.70, 95% CI 0.63–4.55). |
|
| Heart | Diederik van de Beek et al. (2008) | N=313 Median Age: 52 % female n/a |
9% (retrospective chart-review) | n/a | Delirium not related to 1-year mortality (p>0.79) |
Abbreviations: 95%CI, 95% confidence interval; APACHE, Acute Physiology and Chronic Health Evaluation; AST, Aspartate aminotransferase; CAM, Confusion Assessment Method; DRS, Delirium Rating Scale; ICU, intensive care unit; LOS, length of stay; OR, odds ratio; HR, hazard ratio;