Markeri zapaljenja kao prediktori smrtnog ishoda kod bolesnika sa dijagnozom delirijuma
Sažetak
Uvod/Cilj. Delirijum je akutni ili subakutni, najčešće reverzibilni sindrom oštećenja viših kortikalnih funkcija, koji se ispoljava kao generalizovani poremećaj. Ako se ne spreči, povezan je sa mnogostrukim i brzim lošim ishodima. Cilj ovog istraživanja bio je da se ispita povezanost markera zapaljenja i smrtnog ishoda kod bolesnika sa dijagnozom delirijuma, hospitalizovanih u jedinici intenzivne psihijatrijske nege. Metode. Retrospektivnom studijom obuhvaćeno je 120 bolesnika lečenih u jedinici intenzivne psihijatrijske nege pod dijagnozom delirijuma kod kojih je sprovedeno istraživanje razlika markera inflamacije. Ispitanici su bili podeljeni u dve grupe: grupu koju je činilo 40 bolesnika umrlih za vreme bolničkog lečenja, i kontrolnu grupu od 80 preživelih ispitanika koji su otpušteni pod dijagnozom „stanje posle delirijuma“. Praćene su sledeće varijable: starost, pol, klinička dijagnoza infekcije (pneumonija i urinarna infekcija), laboratorijski parametri (ukupni leukociti, granulociti, monociti, C-reaktivni protein − CRP) i tip delirijuma (apstinencijalni ili organski). Rezultati. Prosečna starost ispitanika iznosila je 50,3 ± 13,1 godina. Bolesnici koji su preživeli delirijum bili su prosečno 10,5 godina mlađi od umrlih (p < 0,001). Više od polovine umrlih bolesnika (57,5%) imalo je pneumoniju. Utvrđena je statistički značajna povezanost pneumonije i smrtnog ishoda kod bolesnika sa delirijumom (p < 0,001). U grupi umrlih bolesnika, srednja vrednosti CRP-a bila je statistički značajno veća od vrednosti CRP u grupi preživelih (75,6 ± 54,0 vs 30,3 ± 42,5 ng/L, p < 0,001). Zaključak. U cilju bolje i preciznije dijagnostike ovog komplikovanog i još uvek nejasnog neuropsihijatrijskog sindroma, bilo bi korisno razmotriti uvođenje jasnog dijagnostičkog algoritma u svim jedinicama intenzivne nege. To bi moglo znatno smanjiti broj previda delirijuma, odnosno komplikovanje kliničke slike, stopu loših ishoda, a samim tim i ukupne troškove lečenja.
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