Pasińska P, Wilk A, Kowalska K, Szyper-Maciejowska A, Klimkowicz-Mrowiec A. The long-term prognosis of patients with delirium in the acute phase of stroke: PRospective Observational POLIsh Study (PROPOLIS).
J Neurol 2019;
266:2710-2717. [PMID:
31325015 PMCID:
PMC6803586 DOI:
10.1007/s00415-019-09471-1]
[Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 07/08/2019] [Accepted: 07/11/2019] [Indexed: 01/28/2023]
Abstract
Background and purpose
Delirium is a very common neurobehavioral complication after stroke, but its influence on long-term outcome is not well characterized. The objective of the study was to determine the prognostic significance of delirium for functional status, nursing home admission, and mortality in a large cohort of patients with delirium in the acute phase of stroke assessed 3 and 12 months after stroke.
Methods
All stroke survivors included in PROPOLIS were followed up (n = 682). Outcome data included: discharge destination, recurrence of stroke, cardiovascular complications, functional activity and mobility, nursing home admission, and mortality.
Results
Patients with delirium were discharged to another hospital or nursing home significantly more often than those presenting without delirium. The 3- and 12-month post-stroke mortality rates were higher in delirious patients (OR 6.41 CI 3.76–10.92; p < 0.001 and OR 5.17 CI 3.36–7.96; p < 0.001). When considering 3-month mortality, higher age, modified Rankin Scale prior to admission and temperature between 1 and 3 days after admission, as well delirium, pneumonia and more severe neurological deficits on admission were independent risk factors. For 12-month mortality, the independent risk factors were higher age and modified Rankin Scale post-stroke, delirium, and history of respiratory diseases prior to stroke. Patients with delirium were more likely to live in nursing homes 3 and 12 months after stroke and were more disabled than patients without delirium.
Conclusions
Delirium in acute phase of stroke negatively influences the long-term prognosis. A study addressing the effect of early recognition and treatment of identified modifiable risk factors for adverse long-term outcomes is urgently needed to decrease bad prognosis within this population.
Electronic supplementary material
The online version of this article (10.1007/s00415-019-09471-1) contains supplementary material, which is available to authorized users.
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