Age and Ageing Advance Access published online on July 28, 2007
Age and Ageing, doi:10.1093/ageing/afm094
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Associations of delirium with in-hospital and in 6-months mortality in elderly medical inpatients
1 Department of Ageing and Health, Guy's and St Thomas' NHS Foundation Trust, London, UK
2 Institute of Psychiatry, King's College, London, UK
3 Department of Old Age Psychiatry, Oxleas NHS Trust, London, UK
4 Department of Clinical Neurosciences, King's College, London, UK
Address correspondence to: Dimitrios Adamis. Tel: 020 8836 8520; Fax: 020 8856 5359. Email: dimaadamis{at}yahoo.com
Background: studies on the association between mortality and delirium in older hospital inpatients have produced conflicting results. This insconsistency might be explained by case-mix differences in terms of clinical or underlying patho-physiological processes. For example, both albumin and C-reactive protein (CRP) have been reported as predictors of in-hospital mortality and interleukin-6 of longer-term mortality.
Methods: we used data from a longitudinal study of delirium to investigate the delirium–mortality relationship. A cohort of 164 patients, 70+ years were assessed within 3 days of acute hospital admission and hence twice weekly until hospital discharge, for the presence and severity of delirium and a range of clinical and laboratory measures, including initial albumin (n = 149), CRP (n = 76) and cytokine (n = 60) levels. In-hospital and 6-months mortality were determined from clinical records and telephone contact.
Results: during hospitalisation 14 (8.5%) patients died, 6 with delirium: mortality was not associated with delirium. At 6 months, 119 of 150 (77.3%) discharged patients were still alive, 21 (14.0%) dead, and 13 (8.7%) uncontactable. In bivariate analysis, 6-months mortality was associated with older age (P = 0.013), lower albumin (P = 0.001), higher CRP (P = 0.014) and higher interleukin-6 levels (P = 0.007), but not with presence or severity of in-hospital delirium. After controlling for other variables significant predictors (P < 0.05) for six-month mortality were initial MMSE, albumin, interferon-
and interleukin-6.
Conclusions: the lack of demonstrable association between delirium and mortality may reflect inadequate statistical power in this study due to low numbers. These findings, however, highlight specific patho-physiological factors which may be important in the prognosis after delirium.
Keywords: delirium, elderly, cytokines, albumin, CRP, mortality, outcome, frailty
Received 22 December 2006; accepted in revised form 21 May 2007.
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