title: Postoperative delirium in the intensive care unit predicts worse outcomes in liver transplant recipients.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Critical Care Division, Royal Victoria Hospital, McGill University Health Centre, Montreal, Quebec. thomas.lescot@sat.aphp.fr
authors.forename: Thomas
authors.initials: T
authors.lastname: Lescot
authors.forename: Constantine J
authors.initials: CJ
authors.lastname: Karvellas
authors.forename: Prosanto
authors.initials: P
authors.lastname: Chaudhury
authors.forename: Jean
authors.initials: J
authors.lastname: Tchervenkov
authors.forename: Steven
authors.initials: S
authors.lastname: Paraskevas
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Barkun
authors.forename: Peter
authors.initials: P
authors.lastname: Metrakos
authors.forename: Peter
authors.initials: P
authors.lastname: Goldberg
authors.forename: Sheldon
authors.initials: S
authors.lastname: Magder
mesh_terms: D018806:APACHE; D000368:Aged; D016913:Blood Component Transfusion / Q000706:statistics & numerical data; D015331:Cohort Studies; D003693:Delirium / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008103:Liver Cirrhosis / Q000601:surgery*; D016031:Liver Transplantation / Q000401:mortality / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D011379:Prognosis; D016016:Proportional Hazards Models; D011792:Quebec / Q000453:epidemiology; D017582:Renal Replacement Therapy / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors