Early-onset delirium after spontaneous intracerebral hemorrhage

WHOM has been assigned to solve and figure out ways to prevent this? With NO stroke leadership and NO stroke strategy nothing will be done.

Early-onset delirium after spontaneous intracerebral hemorrhage

Federico Marramahttps://orcid.org/0000-0003-2786-83121,2, Maéva Kyheng3,4, Marco Pasihttps://orcid.org/0000-0001-9976-24591, Matthieu Pierre Rutgers1,5, Solène Moulin1,6, Marina Diomedi2, Didier Leys1, Charlotte Cordonnier1, Hilde Hénon1, and Barbara Casollahttps://orcid.org/0000-0003-4199-995X1,7
 

Objective

 

This study aimed at identifying the incidence, predictors, and impact on long-term mortality and dementia of early-onset delirium in a cohort of patients with spontaneous intracerebral hemorrhage.
 

Methods

 

We prospectively recruited consecutive patients in the Prognosis of InTra-Cerebral Hemorrhage (PITCH) cohort and analyzed incidence rate of early-onset delirium (i.e. during the first seven days after intracerebral hemorrhage onset) with a competing risk model. We used a multivariable Fine-Gray model to identify baseline predictors, a Cox regression model to study its impact on the long-term mortality risk, and a Fine-Gray model adjusted for pre-specified confounders to analyze its impact on new-onset dementia.
 

Results

 

The study population consisted of 248 patients (mean age 70 years, 54% males). Early-onset delirium incidence rate was 29.8% (95% confidence interval (CI) 24.3–35.6). Multivariate analysis showed that pre-existing dementia (subhazard ratio (SHR) 2.08, 95%CI 1.32–3.32, p = 0.002), heavy alcohol intake (SHR 1.79, 95%CI 1.13–2.82, p = 0.013), and intracerebral hemorrhage lobar location (SHR 1.56, 95%CI 1.01–2.42, p = 0.049) independently predicted early-onset delirium. Median follow-up was 9.5 years. Early-onset delirium was associated with higher mortality rates during the first five years of follow-up (HR 1.52, 95%CI 1.00–2.31, p = 0.049), but did not predict new-onset dementia (SHR 1.31, 95%CI 0.60–2.87).
 

Conclusion

 

Early-onset delirium is a frequent complication after intracerebral hemorrhage; it is associated with markers of pre-existing brain vulnerability and with higher mortality risk, but not with higher dementia rates during long-term follow-up.
Keywords
Intracerebral hemorrhage, delirium, long-term outcomes, mortality, dementia
1U1172 – LilNCog-Lille Neuroscience & Cognition, Univ. Lille, Inserm, CHU Lille, Lille, France
2Stroke Center, Department of Systems Medicine, University of Tor Vergata, Rome, Italy
3ULR 2694 – METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, Univ. Lille, CHU Lille, Lille, France
4Département de Biostatistiques, CHU Lille, Lille, France
5Europe Hospitals, Brussels, Belgium
6Department of Neurology, CHU Reims, Reims, France
7Stroke Unit, UR2CA-URRIS Neurology, CHU Pasteur 2, Nice Cote d'Azur University, Nice, France
Corresponding author(s):
Charlotte Cordonnier, Department of Neurology, Stroke unit, Hopital Salengro, CHU, F-59000 Lille, France. Email: charlotte.cordonnier@univ-lille.fr
Introduction
Delirium is an acute, fluctuating and transient disorder of attention and awareness, usually triggered by acute medical conditions.1,2 It occurs in up to one-third of hospitalized elderly patients, and it has been associated with increased mortality and dementia.2–4 In acute stroke settings, reported incidence rates vary between 10 and 48%,5,6 depending on diagnostic methods and stroke subtype.7,8 In most cases, delirium is diagnosed within the first week after stroke.8 International stroke guidelines do not explicitly mention delirium, but evidence-based interventions have been described, including multi-component interventions, environmental factor control, orientation, and frequent mobilizations, making a systematic screening for delirium a potential way to improve post-stroke outcome.9,10 To date, very few studies specifically focused on delirium after intracerebral hemorrhage (ICH), and neither incidence rates nor related clinical and radiological predictors have been fully investigated yet. Moreover, data on the impact of delirium on long-term outcomes after ICH, including mortality and dementia are lacking.
The aim of this study was determining the incidence of early-onset delirium, its predictors and association with mortality, and new-onset dementia after spontaneous ICH.

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