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Título

Impact of Delirium Duration on Stroke Outcomes

Resumo

Background: Delirium is a common complication after stroke and its occurrence is associated with worse outcomes in this population. Longer delirium duration seems to be associated with higher cognitive impairment in critical illness. However, literature is scarce in studies investigating its association with death and functional dependence in stroke patients. Purpose: We aimed to evaluate the impact of delirium duration on stroke prognosis. Methods: Prospective cohort of stroke patients with symptom onset within 72 hours before research admission. Delirium was diagnosed by Confusion Assessment Method in an Intensive Care Unit and coma was defined by Richmond Agitation-Sedation Scale of minus 4 (responsive only to physical stimulus) or minus 5 (unresponsive to physical stimulus). Delirium duration measurement was adjusted by considering as the main predictor the number of days alive free of delirium or coma (DFDC) after admission. We calculated delirium/coma-free days (DCFDs) as follows: DCFDs = 30 – days of delirium – days of coma – days deceased. We did not require that delirium/coma-free days occur consecutively. Our main outcome was functional dependence or death (mRS>2), evaluated by modified Rankin Scale, at 90 days post-ictus. Results: Three hundred sixty three patients were enrolled. Delirium was diagnosed in 85 (23,4) patients, who presented a median number of 25 (19,5-29,0) days alive without delirium or coma. Patients who developed delirium and died or became functionally dependent in long term had fewer DFDC [median (IQR); 25 (17,2-28) vs 29 (26-29) days, p<0,001]. Multivariate analysis showed DFDC (odds ratio, 0,80 [IC 95%, 0,75-0,86]) as an independent predictor of mRS > 2 in 90 days, as well as age, sex, Charlson Comorbidity Index, National Institutes of Health Stroke Scale on admission, thrombolytic treatment and infection occurrence. Conclusion: A first episode of delirium after stroke is usually not the only one, being followed by other days of delirium or coma. Longer duration of delirium is associated with higher risk of death and worse functional outcome in this population. Delirium duration seems to be a parameter of significant clinical relevance, being a valid outcome to be adopted in clinical trials of delirium prevention or mitigation. To our knowledge, it is the first study to investigate prospectively the effect of delirium duration on stroke functional outcome.

Palavras Chave

Stroke; Delirium; Prognosis;