Malissa A Mulkey, Paloma Hauser Paloma Hauser, Julia Aucoin
{"title":"住院血管紧张素转换酶抑制剂和血管紧张素受体阻滞剂与心脏ICU谵妄的关系","authors":"Malissa A Mulkey, Paloma Hauser Paloma Hauser, Julia Aucoin","doi":"10.1080/21548331.2023.2232501","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>Delirium may be associated with neuroinflammation and reduced blood-brain barrier (BBB) stability. ACE Inhibitors (ACEIs) and Angiotensin Receptor Blockers (ARBs) reduce neuroinflammation and stabilize the BBB, thus slowing the progression of memory loss in patients with dementia. This study evaluated the effect of these medications on delirium prevalence.</p><p><strong>Methods: </strong>This was a retrospective study of data from all patients admitted to a Cardiac ICU between 1 January 2020-31 December 2020. The presence of delirium was determined based on the International Classification of Diseases (ICD) 10 codes and nurse delirium screening.</p><p><strong>Results: </strong>Of the 1684 unique patients, almost half developed delirium. Delirious patients who did not receive either ACEI or ARB had higher odds (odds ratio [OR] 5.88, 95% CI 3.7-9.09, <i>P</i> < .001) of in-hospital death and experienced significantly shorter ICU lengths of stay (LOS) (<i>P</i> = .01). There was no significant effect of medication exposure on the time to delirium onset.</p><p><strong>Conclusions: </strong>While ACEIs and ARBs have been shown to slow the progression of memory loss for patients with Alzheimer's disease, we did not observe a difference in time to delirium onset.</p>","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10771528/pdf/","citationCount":"0","resultStr":"{\"title\":\"Relationship between in-hospital angiotensin converting enzyme inhibitors and Angiotensin receptor blockers administration and delirium in the cardiac ICU.\",\"authors\":\"Malissa A Mulkey, Paloma Hauser Paloma Hauser, Julia Aucoin\",\"doi\":\"10.1080/21548331.2023.2232501\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>Delirium may be associated with neuroinflammation and reduced blood-brain barrier (BBB) stability. ACE Inhibitors (ACEIs) and Angiotensin Receptor Blockers (ARBs) reduce neuroinflammation and stabilize the BBB, thus slowing the progression of memory loss in patients with dementia. This study evaluated the effect of these medications on delirium prevalence.</p><p><strong>Methods: </strong>This was a retrospective study of data from all patients admitted to a Cardiac ICU between 1 January 2020-31 December 2020. The presence of delirium was determined based on the International Classification of Diseases (ICD) 10 codes and nurse delirium screening.</p><p><strong>Results: </strong>Of the 1684 unique patients, almost half developed delirium. Delirious patients who did not receive either ACEI or ARB had higher odds (odds ratio [OR] 5.88, 95% CI 3.7-9.09, <i>P</i> < .001) of in-hospital death and experienced significantly shorter ICU lengths of stay (LOS) (<i>P</i> = .01). There was no significant effect of medication exposure on the time to delirium onset.</p><p><strong>Conclusions: </strong>While ACEIs and ARBs have been shown to slow the progression of memory loss for patients with Alzheimer's disease, we did not observe a difference in time to delirium onset.</p>\",\"PeriodicalId\":35045,\"journal\":{\"name\":\"Hospital practice (1995)\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2023-10-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10771528/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Hospital practice (1995)\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1080/21548331.2023.2232501\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2023/7/7 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q2\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Hospital practice (1995)","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1080/21548331.2023.2232501","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2023/7/7 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 0
摘要
目的:谵妄可能与神经炎症和血脑屏障(BBB)稳定性降低有关。ACE抑制剂(ACEIs)和血管紧张素受体阻滞剂(ARBs)可减少神经炎症并稳定血脑屏障,从而减缓痴呆症患者记忆丧失的进展。本研究评估了这些药物对谵妄患病率的影响。方法:这是一项回顾性研究,收集了2020年1月1日至2020年12月31日期间入住心脏ICU的所有患者的数据。根据国际疾病分类(ICD) 10代码和护士谵妄筛查确定谵妄的存在。结果:在1684例独特的患者中,几乎一半发生谵妄。未接受ACEI或ARB治疗的谵妄患者有更高的风险(优势比[or] 5.88, 95% CI 3.7-9.09, P P = 0.01)。药物暴露对谵妄发作时间无显著影响。结论:虽然ACEIs和arb已被证明可以减缓阿尔茨海默病患者记忆丧失的进展,但我们没有观察到谵妄发作时间的差异。
Relationship between in-hospital angiotensin converting enzyme inhibitors and Angiotensin receptor blockers administration and delirium in the cardiac ICU.
Objectives: Delirium may be associated with neuroinflammation and reduced blood-brain barrier (BBB) stability. ACE Inhibitors (ACEIs) and Angiotensin Receptor Blockers (ARBs) reduce neuroinflammation and stabilize the BBB, thus slowing the progression of memory loss in patients with dementia. This study evaluated the effect of these medications on delirium prevalence.
Methods: This was a retrospective study of data from all patients admitted to a Cardiac ICU between 1 January 2020-31 December 2020. The presence of delirium was determined based on the International Classification of Diseases (ICD) 10 codes and nurse delirium screening.
Results: Of the 1684 unique patients, almost half developed delirium. Delirious patients who did not receive either ACEI or ARB had higher odds (odds ratio [OR] 5.88, 95% CI 3.7-9.09, P < .001) of in-hospital death and experienced significantly shorter ICU lengths of stay (LOS) (P = .01). There was no significant effect of medication exposure on the time to delirium onset.
Conclusions: While ACEIs and ARBs have been shown to slow the progression of memory loss for patients with Alzheimer's disease, we did not observe a difference in time to delirium onset.