title: Predisposing risk factors for delirium in living donor liver transplantation patients in intensive care units.
abstract: BACKGROUND
  Delirium is one of the main causes of increased length of intensive care unit (ICU) stay among patients who have undergone living donor liver transplantation (LDLT). We aimed to evaluate risk factors for delirium after LDLT as well as to investigate whether delirium impacts the length of ICU and hospital stay.
  
  
  METHODS
  Seventy-eight patients who underwent LDLT during the period January 2010 to December 2012 at a single medical center were enrolled. The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) scale was used to diagnose delirium. Preoperative, postoperative, and hematologic factors were included as potential risk factors for developing delirium.
  
  
  RESULTS
  During the study period, delirium was diagnosed in 37 (47.4%) patients after LDLT. The mean onset of symptoms occurred 7.0±5.5 days after surgery and the mean duration of symptoms was 5.0±2.6 days. The length of stay in the ICU for patients with delirium (39.8±28.1 days) was significantly longer than that for patients without delirium (29.3±19.0 days) (p<0.05). Risk factors associated with delirium included history of alcohol abuse [odds ratio (OR) = 6.40, 95% confidence interval (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), and duration of endotracheal intubation ≥5 days (OR = 1.81, 95% CI: 1.52-2.23).
  
  
  CONCLUSIONS
  History of alcohol abuse, preoperative hepatic encephalopathy, APACHE II scores ≥16 and endotracheal intubation ≥5 days were predictive of developing delirium in the ICU following liver transplantation surgery and were associated with increased length of ICU and hospital stay.
authors.affiliation: Organ Transplant Center, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Szu-Han
authors.initials: SH
authors.lastname: Wang
authors.affiliation: Department of Health Care Administration, Asia University, Taichung, Taiwan.
authors.forename: Jiun-Yi
authors.initials: JY
authors.lastname: Wang
authors.affiliation: Transplant Medicine & Surgery Research Centre, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Ping-Yi
authors.initials: PY
authors.lastname: Lin
authors.affiliation: Department of General Surgery, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Kuo-Hua
authors.initials: KH
authors.lastname: Lin
authors.affiliation: Department of General Surgery, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Chih-Jan
authors.initials: CJ
authors.lastname: Ko
authors.affiliation: Organ Transplant Center, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Chia-En
authors.initials: CE
authors.lastname: Hsieh
authors.affiliation: Department of Senior Citizen Welfare and Business, Hung Kuang University, Taichung, Taiwan.
authors.forename: Hui-Chuan
authors.initials: HC
authors.lastname: Lin
authors.affiliation: Department of General Surgery, Changhua Christian Hospital, Changhua, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan; School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Yao-Li
authors.initials: YL
authors.lastname: Chen
mesh_terms: D003693:Delirium / Q000209:etiology*; D004198:Disease Susceptibility; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D016031:Liver Transplantation / Q000009:adverse effects*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors