Prevalence of delirium in gastroenterology/hepatology units: A cross-sectional study

Abstract

Prevalence rates of delirium amount to 22.0% within acute-care settings. In contrast, 30–40% of patients with liver cirrhosis may develop hepatic encephalopathy, a condition that has been classified as a syndrome of delirium, based on recent pathophysiology findings. However, the prevalence of delirium in gastroenterology and hepatology units is unknown.

The aims of the study were (i) to identify delirium prevalence rates in inpatients of gastroenterology/hepatology wards, (ii) to analyze the delirium motor subtype, and (iii) to assess associations between delirium and patient characteristics.

In this monocentric, cross-sectional, epidemiological study, point prevalence was assessed at six time points in three gastroenterology/hepatology units within a German university hospital. Delirium was assessed using the 4 ‘As’ Test (4AT) and delirium subtype by the delirium motor subtype scale. Patient characteristics were collected from patient charts.

The sample consisted of 188 patients, aged 18 to 98 years (mean age 64, n=110 male). Of them, 18.1% of patients showed delirium symptoms (61.8% hypoactive, 29.4% mixed, and 8.8% hyperactive). For the participants aged ≥65 years (n=96), prevalence of delirium amounted to 26.0%. Significant associations were observed between delirium and the following characteristics: age (p=0.001), length of hospital stay until assessment (p=0.043), cerebrovascular disease (p=0.002), dementia (p=0.010), diabetes mellitus with chronic complications (p=0.012), and gender (nonsignificant trend, p=0.050), while no association was detected between moderate or severe liver disease and delirium (p=0.414).

In conclusion, overall prevalence rates of delirium were rather low and did not increase in patients with liver disease.

Zusammenfassung

In Akutkrankenhäusern wird von einer Delirprävalenz von ca. 22 % ausgegangen. In der Gastroenterologie/Hepatologie werden höhere Prävalenzen erwartet, da 30–40 % der Patient*innen mit Leberzirrhose im Verlauf ihrer Erkrankung eine Hepatische Enzephalopathie entwickeln, die als delirantes Syndrom verstanden werden kann.

Ziele dieser Studie waren (1) die Ermittlung der Delirprävalenz stationärer Patient*innen in der Gastroenterologie/Hepatologie, (2) die Analyse des motorischen Delirsubtyps sowie (3) die Zusammenhänge von Delir mit patientenbezogenen Charakteristika zu erfassen.

In einer monozentrischen Querschnittstudie wurde zu sechs Zeitpunkten die Prävalenz auf drei gastroenterologischen/hepatologischen Normalstationen einer Universitätsklinik erhoben. Das Delir wurde anhand des 4-‚A‘-Tests (4AT) erfasst, der Motor Subtyp mit Hilfe der ‚Delirium Motor Subtype Scale‘, patient*innenbezogene Charakteristika wurden den Patient*innenakten entnommen.

Die Stichprobe umfasste 188 Patient*innen im Alter von 19–98 Jahren (Durchschnitt 64 Jahre, n=110 männliche Teilnehmer). 18,1 % wiesen Symptome eines Delirs auf (61,8 % hypoaktiv, 29,4 % gemischt, 8,8 % hyperaktiv). Die Prävalenz eines Delirs in der Altersklasse ≥65 Jahre (n=96) betrug 26,0 %. Es konnten signifikante Zusammenhänge zwischen Delir und folgenden Charakteristika nachgewiesen werden: Alter (p=0,001), Länge des Aufenthalts bis zur Erhebung (p=0,043), zerebrovaskuläre Erkrankungen (p=0,002), Demenz (p=0.010), Diabetes mellitus mit Endorganschäden (p=0,012), sowie eine Tendenz bezüglich des Geschlechts (p=0,050). Im Gegensatz dazu bestand kein Zusammenhang zwischen moderater bis schwerer Lebererkrankung und dem Auftreten eines Delirs (p=0,414).

Zusammenfassend wies die hier untersuchte Stichprobe eine geringe Delirsymptomatik auf. Die Prävalenz eines Delirs bei Patient*innen mit Lebererkrankungen war nicht erhöht.

Schlüsselwörter

Delir - Delirprävalenz - Gastroenterologie - Hepatologie - Hepatische Enzephalopathie

Keywords

Delirium - Prevalence - Gastroenterology - Hepatology - Hepatic Encephalopathy

Publication History

Received: 20 September 2021

Accepted after revision: 24 May 2023

Article published online:
16 August 2023

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