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Canadian Journal of Gastroenterology
Volume 27, Issue 4, Pages 207-212
http://dx.doi.org/10.1155/2013/289185
Original Article

Postoperative Delirium in the Intensive Care Unit Predicts Worse Outcomes in Liver Transplant Recipients

Thomas Lescot,1 Constantine J Karvellas,2 Prosanto Chaudhury,3 Jean Tchervenkov,3 Steven Paraskevas,3 Jeffrey Barkun,3 Peter Metrakos,3 Peter Goldberg,1 and Sheldon Magder1

1Critical Care Division, Royal Victoria Hospital, McGill University Health Centre, Montreal, Quebec, Canada
2Division of Gastroenterology (Liver Unit) and Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada
3Department of Surgery and Multi-Organ Transplant Program, Victoria Hospital, McGill University Health Centre, Montreal, Canada

Received 20 April 2012; Accepted 30 January 2013

Copyright © 2013 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

BACKGROUND: Delirium is common in intensive care unit patients and is associated with worse outcome.

OBJECTIVE: To identify early risk factors for delirium in patients admitted to the intensive care unit following orthotopic liver transplantation (OLT).

METHODS: An observational study of patients admitted to the intensive care unit from January 2000 to May 2010 for elective or semi-elective OLT was conducted. The primary end point was delirium in the intensive care unit. Pre- and post-transplantation and intraoperative factors potentially associated with this outcome were examined.

RESULTS: Of the 281 patients included in the study, 28 (10.03%) developed delirium in the intensive care unit at a median of two days (interquartile range one to seven days) after OLT. According to multivariate analysis, independent risk factors for delirium were intraoperative transfusion of packed red blood cells (OR 1.15 [95% CI 1.01 to 1.18]), renal replacement therapy during the pretransplantation period (OR 13.12 [95% CI 2.82 to 72.12]) and Acute Physiologic and Health Evaluation (APACHE) II score (OR per unit increase 1.10 [95% CI 1.03 to 1.29]). Using Cox proportional hazards models adjusted for baseline covariates, delirium was associated with an almost twofold risk of remaining in hospital, a fourfold increased risk of dying in hospital and an almost threefold increased rate of death by one year.

CONCLUSION: Intraoperative transfusion of packed red blood cells, pretransplantation renal replacement therapy and APACHE II score are predictors for the development of delirium in intensive care unit patients post-OLT and are associated with increased hospital lengths of stay and mortality.