PUBLICATION #1 — Transplant Psychiatry
The association of post-operative delirium with patient-reported outcomes and mortality after lung transplantation.
DeBolt CL, Gao Y, Sutter N, Soong A, Leard L, Jeffrey G, Kleinhenz ME, Calabrese D, Greenland J, Venado A, Hays SR, Shah R, Kukreja J, Trinh B, Kolaitis NA, Douglas V, Diamond JM, Smith P, Singer J.
Abstract: Clin Transplant. 2021 Mar 7;e14275. doi: 10.1111/ctr.14275. Online ahead of print.
Post-operative delirium after lung transplantation is common. Its associations with health-related quality of life (HRQL), depression, and mortality remains unknown. In 236 lung transplant recipients, HRQL and depressive symptoms were assessed as part of a structured survey battery before and after transplantation. Surveys included the Geriatric Depressive Scale (GDS) and Short Form 12 (SF12). Delirium was assessed throughout the post-operative intensive care unit (ICU) stay with Confusion Assessment Method for ICU. Delirium and mortality data were extracted from electronic medical records. We examined associations between delirium and changes in depressive symptoms and HRQL using linear mixed effects models and association between delirium and mortality with Cox-proportional hazard models. Post-operative delirium occurred in 34 participants (14%). Delirium was associated with attenuated improvements in SF12-PCS (difference ₋4.0; 95%CI: -7.4, -0.7) but not SF12-MCS (difference 2.2; 95%CI: -0.7,5.7) or GDS (difference ₋0.4; 95%CI: -1.5,0.7). Thirty-two participants died during the study period. Delirium was associated with increased adjusted hazard risk of mortality (HR 17.9, 95%CI: 4.4,72.5). Delirium after lung transplantation identifies a group at increased risk for poorer HRQL and death within the first post-operative year. Further studies should investigate potential causal links between delirium, and poorer HRQL and mortality risk after lung transplantation.
Critical care medicine; delirium; delirium outcomes; lung transplant; lung transplantation.
This prospective cohort study performed secondary analysis of the “Breath Again” study, evaluating adults undergoing first-time lung transplantation between January 2010 and April 2017. While patients were in the ICU, delirium was identified through the Confusion Assessment Method for the ICU (CAM-ICU). Associations between delirium, depressive symptoms, Health-Related Quality of Life (HRQL), and mortality were examined. Post-operative delirium was evident in 14% of the participants, increased risk of mortality, and worsened HRQL.
Strength and weaknesses:
The study identified delirium as a risk factor for mortality and decreased quality of life. This study had several strengths including the large cohort of lung transplant patients. There was limited missing data. Some limitations include the lower-than-expected rate of delirium as compared to other published studies.
This study is relevant for C-L psychiatrists who evaluate or manage lung transplant patients. While evaluating patients pre-transplant, steps should be taken to help reduce risk of post-operative delirium. Interventions include simplifying medication regimens and avoiding deliriogenic medications such as benzodiazepine and antihistamines. There is significant need to further explore the association between delirium and mortality.
Type of study:
Prospective cohort study