Exploring factors influencing delirium incidence: Insights from the Alzira cohort study, 2012–2021 | Revista Española de Geriatría y Gerontología

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Fuente: elaboración propia." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Esther Sánchez Sánchez, Inmaculada Montero García" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Esther" "apellidos" => "Sánchez Sánchez" ] 1 => array:2 [ "nombre" => "Inmaculada" "apellidos" => "Montero García" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0211139X2400074X?idApp=UINPBA00004N" "url" => "/0211139X/unassign/S0211139X2400074X/v1_202407240435/es/main.assets" ] "en" => array:18 [ "idiomaDefecto" => true "cabecera" => "Brief report" "titulo" => "Exploring factors influencing delirium incidence: Insights from the Alzira cohort study, 2012–2021" "tieneTextoCompleto" => true "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Daniela Villalón Rubio, Elisa García Tercero, Jesús López Gómez, Hugo González, Ángel Belenguer Varea, Cristina Cunha-Pérez, Miguel Germán Borda, Francisco José Tarazona-Santabalbina" "autores" => array:8 [ 0 => array:4 [ "nombre" => "Daniela Villalón" "apellidos" => "Rubio" "email" => array:1 [ 0 => "dandrea.villalon@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Elisa García" "apellidos" => "Tercero" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Jesús López" "apellidos" => "Gómez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Hugo" "apellidos" => "González" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "Ángel Belenguer" "apellidos" => "Varea" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "Cristina" "apellidos" => "Cunha-Pérez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 6 => array:3 [ "nombre" => "Miguel Germán" "apellidos" => "Borda" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "d" "identificador" => "aff0020" ] ] ] 7 => array:3 [ "nombre" => "Francisco José" "apellidos" => "Tarazona-Santabalbina" "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] 2 => array:2 [ "etiqueta" => "e" "identificador" => "aff0025" ] ] ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "Geriatric Medicine Department, Hospital Universitario de la Ribera, Carretera de Corbera km. 1, 46600 Alzira, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Geriatría, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Medical School, Universidad Católica de Valencia Sant Vicent Màrtir, 46001 Valencia, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Centro de Investigación Biomédica en Red Fragilidad y Envejecimiento Saludable (CIBERFES), 28029 Madrid, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Explorando factores que influyen en la incidencia de delirium. Análisis de datos de la cohorte retrospectiva Alzira 2012-2021" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 3957 "Ancho" => 3184 "Tamanyo" => 491859 ] ] "descripcion" => array:1 [ "en" => "Kaplan–Meier curves at one, 2 and 5 years in patients with delirium vs. without delirium (La Ribera University Hospital)." ] ] ] "textoCompleto" => "IntroductionThe older adult population is growing worldwide.<a class="elsevierStyleCrossRef" href="#bib0080">1</a> Falls and hip fractures are one of the major complications leading to hospitalization among this age group. The European Commission estimates that annual hip fractures will rise by 135%, from 414,000 in 1998 to 972,000 by 2050.<a class="elsevierStyleCrossRef" href="#bib0085">2</a>Delirium is a leading complication during hospitalization for hip fractures.<a class="elsevierStyleCrossRef" href="#bib0090">3</a> Its general prevalence in hospitalized older adults ranges from 28.1% to 36.5%<a class="elsevierStyleCrossRefs" href="#bib0095">4,5</a> with estimates suggesting it can occur in up to 60% of the hip fracture cases.<a class="elsevierStyleCrossRef" href="#bib0105">6</a> Delirium is a geriatric syndrome that manifests as a sudden deterioration in consciousness, cognitive function, and attention due to multifactorial causes.<a class="elsevierStyleCrossRef" href="#bib0110">7</a> The most accepted theories on the pathogenesis of delirium link it to inflammation, chronic stress, neurotransmitter imbalances, and electrolyte or metabolic derangements.<a class="elsevierStyleCrossRef" href="#bib0115">8</a> Some basic pathways have been investigated but all the process of delirium in hip fractures has not been widely understood.Delirium is a multifactorial syndrome.<a class="elsevierStyleCrossRef" href="#bib0090">3</a> In hospitalized older adults, predisposing factors include advanced age, cognitive impairment, cardiovascular diseases, comorbidities, central nervous system disorders, alcohol use, male sex, depression, diabetes, malnutrition, lower education, tobacco use, anemia, psychiatric disorders, multiple medications, and less commonly, female sex, malignant neoplasms, pulmonary disease, pain, and chronic kidney disease.<a class="elsevierStyleCrossRef" href="#bib0120">9</a> Precipitating factors include surgery type, anesthesia, neurological and kidney injury, infections, respiratory disease, pain, and certain medications (e.g., benzodiazepines, opioids, sedatives, anticholinergics, neuroleptics). Environmental factors like urinary catheters, physical restraints, immobilization, sleep disturbances, and ICU admission also contribute to delirium onset. Some factors are both predisposing and precipitating.In older adults, delirium is linked to adverse outcomes, including impaired functional and cognitive recovery, prolonged hospital stays, increased healthcare costs, and elevated mortality rates.<a class="elsevierStyleCrossRef" href="#bib0125">10</a> A comprehensive understanding of the factors associated with delirium incidence among older adults with hip fractures could allow us to development more effective preventive strategies that decrease these adverse outcomes.Hence, the main objective of this study is to determine the incidence of delirium and its association with several factors during hospitalization, as well as its impact on short-, medium-, and long-term survival among older adults with hip fractures.MethodologyA retrospective cohort study, the Alzira Retrospective Cohort, involved 3226 older adults (mean age 85.3 years, SD 6; 68% women) admitted to the Hospital Universitario de la Ribera in Alzira, Valencia, with hip fractures between January 2012 and December 2021. Patients aged 70 and older with documented hip fractures who consented were included. Exclusion criteria were pathological fractures, high-impact trauma fractures, and life expectancy under 6 months.Data was extracted from the hospital's electronic medical records. Delirium was assessed daily during hospital stay by geriatric doctors or nurses using the validated 4AT scale in Spanish.<a class="elsevierStyleCrossRef" href="#bib0130">11</a> Variables included socio-demographic factors, comorbidities, and medical and surgical complications. Cognitive status was assessed with the Global Deterioration Scale. Initial and final CONUT index, hemoglobin, and glomerular filtration rate were collected by blood analysis on the day of admission and discharge, respectively.The follow-up was two years, with a five-year analysis for a subgroup, that completed this time. Survival rates were collected from dates of death through hospital records.The study adhered to the Helsinki Declaration and Spanish clinical research legislation. Approval was obtained from the Research Ethics Committee (CEIC) of the Hospital Universitario de la Ribera, reference code HULR2312202.Statistical analysisQualitative variables were described using raw scores and corresponding percentages, with bivariate analysis conducted utilizing the Chi-squared technique. Quantitative variables were expressed as means accompanied by standard deviations, and bivariate analysis was performed employing the t-test. Multivariate analysis entailed Cox regression analysis, complemented by Kaplan–Meier survival curves, to explore the association between delirium and survival.ResultsThe prevalence of delirium in the study population was 10.9% (n=353). Patients diagnosed with delirium were found to be older and had a higher prevalence of dementia and chronic renal failure. Additionally, they experienced longer hospital stays and exhibited a greater number of overall complications, including cardiac complications, anemia, and urinary tract infections (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>The crude and age adjusted Charlson comorbidity index scores, as well as the number of ICU admissions, showed no significant differences between groups. Similarly, there were no disparities observed in the percentage of patients readmitted, timing of intervention, or levels of hemoglobin and glomerular filtration rate at admission and discharge. This trend persisted for pre-admission diagnoses of chronic obstructive pulmonary disease (COPD), cerebrovascular disease, diabetes, heart failure, or ischemic heart disease (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).Survival analysis conducted through the Kaplan–Meier technique revealed elevated mortality rates at 1, 2, and 5 years among patients with delirium (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> and <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). Further analysis via Cox regression survival analysis indicated that factors contributing to the association between delirium and mortality included male gender, advanced age, presence of a cardiac event upon admission, Cumulative Illness Rating Scale for Geriatrics (CIRS-G) score, and the highest recorded score on the CONUT index.<elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia>DiscussionIn this study, the history of dementia and chronic renal failure, as well as a higher scores on the CIRS-G and CONUT index were related to delirium. Additionally, delirium was correlated with an increased number of admission complications, particularly cardiac complications, anemia and urinary tract infections.Several studies have underscored the association between delirium and factors such as dementia, medical comorbidities, and postoperative complications including urinary tract infections and pneumonia, all of which heighten the risk of delirium occurrence.<a class="elsevierStyleCrossRef" href="#bib0135">12</a> In fact, malnutrition and previous functional dependency have been implicated in increasing both morbidity and mortality rates among patients.<a class="elsevierStyleCrossRef" href="#bib0090">3</a>These results could be explained thanks to the relationship between the pathophysiological mechanisms of delirium: the neurotransmitter chemical alterations, inflammatory storm and chronic stress. Some studies has pointed to a lack of cholinergic activity, due to high dopamine levels<a class="elsevierStyleCrossRef" href="#bib0115">8</a> and alterations in melatonina, serotonin, histamine, norepinephine or glutamate release.<a class="elsevierStyleCrossRef" href="#bib0120">9</a> The loss of brain functional reserve decreases the cerebral blood flow and the number of neurotransmitters, this added to neurological stress cause by an infection or a metabolic alteration could development delirium.<a class="elsevierStyleCrossRefs" href="#bib0105">6,8,9</a> Inflammation state may cause delirium by way of stress-induced cytokines and microglial reactivity.<a class="elsevierStyleCrossRef" href="#bib0120">9</a> Additional, physical stress (pain, blood loss, tissue damage) stimulates interleukins secretion which produce changes in the permeability of blood- brain barrier<a class="elsevierStyleCrossRef" href="#bib0105">6</a>; other stressors like hipoxia, extremes in temperatura, glucosa levels, electrolyte and direct injury (stroke or trauma) may also disrupt neuronal activity.<a class="elsevierStyleCrossRef" href="#bib0120">9</a>In addition, we report that patients with delirium exhibited prolonged hospital stays and elevated short-, medium-, and long-term mortality rates compared to those without delirium. These findings are consistent with previous research conducted at our center, which identified delirium as a predictor of poorer functional recovery and elevated long-term mortality.<a class="elsevierStyleCrossRef" href="#bib0140">13</a>Delirium was significantly associated with advanced age and male gender. Advanced age emerges as a significant risk factor for delirium, with individuals aged over 71 years exhibiting a threefold increased risk of delirium development.<a class="elsevierStyleCrossRef" href="#bib0150">15</a> Moreover, while hip fractures are more prevalent in women, postoperative delirium is more frequently observed in men.<a class="elsevierStyleCrossRef" href="#bib0135">12</a>The prevalence of delirium found was 11%. Previous literature in other populations has reported varying prevalence rates, influenced by factors such as the type of population, location, setting, and age. For example, the prevalence of postoperative delirium among nonagenarians with hip fractures is reported to be 28.1%,<a class="elsevierStyleCrossRef" href="#bib0095">4</a> in patients aged 85 years 36.5%,<a class="elsevierStyleCrossRef" href="#bib0100">5</a> and in younger patients, around 76 years, 17%.<a class="elsevierStyleCrossRef" href="#bib0145">14</a>The main limitations of the study are its retrospective design, which includes the typical biases associated with the recruitment of data from medical records. There was limited information on functional status and dementia severity, which could be confounding factors. Additionally, there might be an underdiagnosis of hypoactive delirium. Moreover, the data recorded by doctors and nurses may not reflect the most accurate information to confidently apply the 4AT, potentially leading to an underestimation of the true delirium incidence. The measures used to prevent delirium within orthogeriatric care could also be related to the reported lower prevalence when compared to the available literature.The main strengths are the five-year follow-up carried out on the subgroup that reached that period, and the sample size obtained in a group of patients with similar characteristics. This study was conducted in a real-world hospital setting, the study's findings reflect a typical clinical environment, enhancing the external validity of the results.In conclusion, delirium is associated to pathologies and complications, which have an impact in patient hospitalization, some of these are potentially preventable like nutritional deterioration, worsening of anemia severity, urinary tract infection after urinary catheterization and adequate intravenous hydration to avoid cardiac complication due to fluid overload. For these reasons, an early identification and treatment of these factors joined to an early diagnosis of delirium could decrease the mortality in older adults with hospital admission by hip fracture.Conflict of interestThe authors declare that they have no conflict of interest." 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This study aims to determine the incidence of delirium and its correlation with various factors during hospitalization, as well as its impact on short-, medium-, and long-term survival. MethodologyA retrospective cohort study was undertaken to examine hospital admissions of individuals aged 70 years or older diagnosed with hip fractures at the Hospital Universitario La Ribera in Alzira, Valencia, from January 2012 to December 2021. ResultsA total of 3226 patients were recruited, mean of 85 years, 73.7% females, 26.3% males. Delirium was observed in 10.9% of patients during hospitalization (68.8% females, p=0.029). Patients diagnosed with delirium exhibited a greater prevalence of dementia (25.2%, p<0.001) and chronic kidney disease (14.7%, p=0.018). Delirium was also significantly associated with older age (mean 86.5 years [SD 5.6], p<0.001), increased number of complications (mean 1.4 [SD 1.6], p<0.001), cardiac complications (9.1%, p=0.036), anemia (21.7%, p<0.001), and urinary tract infections (7.4%, p<0.001) during hospitalization. Furthermore, patients with delirium experienced a prolonged hospital stay (mean 9 vs. 7.9 days, p<0.001) and significantly higher short-, medium-, and long-term mortality rates. DiscussionThe study findings underscore a significant association between delirium and comorbidities, complications, and mortality. Early identification of patients at risk for delirium will allow us to implement targeted interventions focused on prevention to enhance patient outcomes." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methodology" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Discussion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "IntroducciónLa fractura de cadera es una afección común en los adultos mayores, que se relaciona con un incremento de complicaciones como el delirium, un síndrome geriátrico asociado a una mayor estancia hospitalaria, peor recuperación funcional y menor supervivencia. El objetivo del estudio es determinar la incidencia de delirium y su correlación con diversos factores durante la hospitalización, como su impacto en la supervivencia a corto, mediano y largo plazo. MetodologíaSe diseñó un estudio de cohorte retrospectiva con los ingresos hospitalarios de adultos de edad igual o superior a 70 años, con diagnóstico de fractura de cadera efectuados en el Hospital Universitario La Ribera (Alzira, Valencia) desde enero de 2012 a diciembre de 2021. ResultadosSe reclutaron 3.226 pacientes, con edad media de 85 años, el 73,7% mujeres y el 26,3% varones. El 10,9% de los pacientes presentó delirium durante la hospitalización (68,8% mujeres; p=0,029). Los pacientes con delirium presentaron mayor prevalencia de demencia (25,2%; p<0,001) y enfermedad renal crónica (14,7%; p=0,018). Asimismo, el delirium se asoció significativamente a mayor edad (media: 86,5 años [DE: 5,6]; p<0,001), número de complicaciones (media: 1,4 [DE: 1,6]; p<0,001), complicaciones cardiacas (9,1%; p=0,.036), anemia (21,8%, p<0,001) e infecciones de tracto urinario (7,4%; p<0,001) durante la hospitalización. Aquellos con delirium tuvieron mayor estancia hospitalaria (9 vs. 7,9 días; p<0,001) como mayor mortalidad a corto, medio y largo plazo. DiscusiónEl estudio muestra una asociación significativa entre la presencia de delirium, y comorbilidades, complicaciones y mortalidad. El identificar tempranamente a los pacientes con riesgo de delirium, nos permitirá implementar acciones preventivas para mejorar la recuperación de nuestros pacientes." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Metodología" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Discusión" ] ] ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 3957 "Ancho" => 3184 "Tamanyo" => 491859 ] ] "descripcion" => array:1 [ "en" => "Kaplan–Meier curves at one, 2 and 5 years in patients with delirium vs. without delirium (La Ribera University Hospital)." ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "CIRS-G: Cumulative Illness Rating Scale for Geriatrics score, CONUT: control nutritional index, COPD: Chronic Obstructive Pulmonary Disease." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Deliriumn=353 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">No deliriumn=2873 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p-Value \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">86.5 (5.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">84.1 (6.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sex</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.029 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">243 (68.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2136 (74.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">110 (31.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">737 (25.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Charlson index \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.5 (2.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.5 (2.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.653 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CIRS-G \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12.6 (4.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11.2 (4.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hospital stay (days) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9.0 (4.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.9 (3.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Number of complications \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.4 (1.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.0 (1.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Number of major complications \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.2 (1.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.9 (1.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.313 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Surgical delay (hours) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">47.3 (29.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45.1 (31.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.203 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Initial CONUT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.3 (2.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.1 (2.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Final CONUT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.5 (2.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.0 (2.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Initial hemoglobin (mg/dl) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12.1 (1.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12.3 (1.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.630 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Final hemoglobin (mg/dl) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10.4 (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10.2 (1.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.337 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Initial glomerular filtration (ml/min/1.73m2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">63.9 (22.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">63.2 (24.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.769 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Final glomerular filtration (ml/min/1.73m2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">84.5 (40.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">79.7 (35.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.141 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dementia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">89 (25.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">402 (14%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Chronic renal failure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">52 (14.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">298 (10.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.018 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">COPD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">37 (10.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">336 (11.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.538 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diabetes mellitus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">98 (27.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">819 (28.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.803 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Stroke \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13 (3.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">69 (2.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.151 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ischemic heart disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">34 (9.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">221 (7.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.209 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Heart Failure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27 (7.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">173 (6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.241 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cardiac complication during admission \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">32 (9.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">173 (6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.036 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Anemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">77 (21.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">287 (10%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Urinary infection \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26 (7.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">94 (3.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ICU admissions \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (1.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">32 (1.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.594 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Readmission rates \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36 (10.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">444 (15.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.009 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3662429.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Characteristics of patients admitted for hip fracture (La Ribera University Hospital)." ] ] 2 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Deliriumn=353 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">No deliriumn=2873 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p-Value \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">In-hospital mortality \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 (3.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">122 (4.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.571 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mortality 30 days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30 (8.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">221 (7.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.598 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mortality 90 days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">70 (19.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">397 (13.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.004 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mortality 180 days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">105 (29.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">531 (18.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mortality 365 days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">128 (36.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">718 (25%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mortality at 2 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">187 (53%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1158 (40.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mortality at 5 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">297 (84.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2214 (77.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.002 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3662428.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Mortality of patients admitted for hip fracture (La Ribera University Hospital)." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:15 [ 0 => array:3 [ "identificador" => "bib0080" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ageing and health [Internet]" "autores" => array:1 [ 0 => array:2 [ "colaboracion" => "World Health Organization" "etal" => false ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:1 [ "fecha" => "2022" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0085" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "European Commission. 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Exploring factors influencing delirium incidence: Insights from the Alzira cohort study, 2012–2021

Explorando factores que influyen en la incidencia de delirium. Análisis de datos de la cohorte retrospectiva Alzira 2012-2021

Daniela Villalón Rubioa,

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dandrea.villalon@gmail.com

Corresponding author.

, Elisa García Terceroa, Jesús López Gómeza, Hugo Gonzálezb, Ángel Belenguer Vareaa, Cristina Cunha-Pérezc, Miguel Germán Bordad, Francisco José Tarazona-Santabalbinaa,c,e

a Geriatric Medicine Department, Hospital Universitario de la Ribera, Carretera de Corbera km. 1, 46600 Alzira, Spain

b Departamento de Geriatría, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile

c Medical School, Universidad Católica de Valencia Sant Vicent Màrtir, 46001 Valencia, Spain

d Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway

e Centro de Investigación Biomédica en Red Fragilidad y Envejecimiento Saludable (CIBERFES), 28029 Madrid, Spain

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        "titulo" => "Explorando factores que influyen en la incidencia de <span class="elsevierStyleItalic">delirium</span>&#46; An&#225;lisis de datos de la cohorte retrospectiva Alzira 2012-2021"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The older adult population is growing worldwide&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">1</span></a> Falls and hip fractures are one of the major complications leading to hospitalization among this age group&#46; The European Commission estimates that annual hip fractures will rise by 135&#37;&#44; from 414&#44;000 in 1998 to 972&#44;000 by 2050&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Delirium is a leading complication during hospitalization for hip fractures&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a> Its general prevalence in hospitalized older adults ranges from 28&#46;1&#37; to 36&#46;5&#37;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">4&#44;5</span></a> with estimates suggesting it can occur in up to 60&#37; of the hip fracture cases&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">6</span></a> Delirium is a geriatric syndrome that manifests as a sudden deterioration in consciousness&#44; cognitive function&#44; and attention due to multifactorial causes&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">7</span></a> The most accepted theories on the pathogenesis of delirium link it to inflammation&#44; chronic stress&#44; neurotransmitter imbalances&#44; and electrolyte or metabolic derangements&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">8</span></a> Some basic pathways have been investigated but all the process of delirium in hip fractures has not been widely understood&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Delirium is a multifactorial syndrome&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a> In hospitalized older adults&#44; predisposing factors include advanced age&#44; cognitive impairment&#44; cardiovascular diseases&#44; comorbidities&#44; central nervous system disorders&#44; alcohol use&#44; male sex&#44; depression&#44; diabetes&#44; malnutrition&#44; lower education&#44; tobacco use&#44; anemia&#44; psychiatric disorders&#44; multiple medications&#44; and less commonly&#44; female sex&#44; malignant neoplasms&#44; pulmonary disease&#44; pain&#44; and chronic kidney disease&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">9</span></a> Precipitating factors include surgery type&#44; anesthesia&#44; neurological and kidney injury&#44; infections&#44; respiratory disease&#44; pain&#44; and certain medications &#40;e&#46;g&#46;&#44; benzodiazepines&#44; opioids&#44; sedatives&#44; anticholinergics&#44; neuroleptics&#41;&#46; Environmental factors like urinary catheters&#44; physical restraints&#44; immobilization&#44; sleep disturbances&#44; and ICU admission also contribute to delirium onset&#46; Some factors are both predisposing and precipitating&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">In older adults&#44; delirium is linked to adverse outcomes&#44; including impaired functional and cognitive recovery&#44; prolonged hospital stays&#44; increased healthcare costs&#44; and elevated mortality rates&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">10</span></a> A comprehensive understanding of the factors associated with delirium incidence among older adults with hip fractures could allow us to development more effective preventive strategies that decrease these adverse outcomes&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Hence&#44; the main objective of this study is to determine the incidence of delirium and its association with several factors during hospitalization&#44; as well as its impact on short-&#44; medium-&#44; and long-term survival among older adults with hip fractures&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methodology</span><p id="par0030" class="elsevierStylePara elsevierViewall">A retrospective cohort study&#44; the Alzira Retrospective Cohort&#44; involved 3226 older adults &#40;mean age 85&#46;3 years&#44; SD 6&#59; 68&#37; women&#41; admitted to the Hospital Universitario de la Ribera in Alzira&#44; Valencia&#44; with hip fractures between January 2012 and December 2021&#46; Patients aged 70 and older with documented hip fractures who consented were included&#46; Exclusion criteria were pathological fractures&#44; high-impact trauma fractures&#44; and life expectancy under 6 months&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Data was extracted from the hospital&#39;s electronic medical records&#46; Delirium was assessed daily during hospital stay by geriatric doctors or nurses using the validated 4AT scale in Spanish&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">11</span></a> Variables included socio-demographic factors&#44; comorbidities&#44; and medical and surgical complications&#46; Cognitive status was assessed with the Global Deterioration Scale&#46; Initial and final CONUT index&#44; hemoglobin&#44; and glomerular filtration rate were collected by blood analysis on the day of admission and discharge&#44; respectively&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The follow-up was two years&#44; with a five-year analysis for a subgroup&#44; that completed this time&#46; Survival rates were collected from dates of death through hospital records&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The study adhered to the Helsinki Declaration and Spanish clinical research legislation&#46; Approval was obtained from the Research Ethics Committee &#40;CEIC&#41; of the Hospital Universitario de la Ribera&#44; reference code HULR2312202&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Statistical analysis</span><p id="par0050" class="elsevierStylePara elsevierViewall">Qualitative variables were described using raw scores and corresponding percentages&#44; with bivariate analysis conducted utilizing the Chi-squared technique&#46; Quantitative variables were expressed as means accompanied by standard deviations&#44; and bivariate analysis was performed employing the <span class="elsevierStyleItalic">t</span>-test&#46; Multivariate analysis entailed Cox regression analysis&#44; complemented by Kaplan&#8211;Meier survival curves&#44; to explore the association between delirium and survival&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Results</span><p id="par0055" class="elsevierStylePara elsevierViewall">The prevalence of delirium in the study population was 10&#46;9&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>353&#41;&#46; Patients diagnosed with delirium were found to be older and had a higher prevalence of dementia and chronic renal failure&#46; Additionally&#44; they experienced longer hospital stays and exhibited a greater number of overall complications&#44; including cardiac complications&#44; anemia&#44; and urinary tract infections &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">The crude and age adjusted Charlson comorbidity index scores&#44; as well as the number of ICU admissions&#44; showed no significant differences between groups&#46; Similarly&#44; there were no disparities observed in the percentage of patients readmitted&#44; timing of intervention&#44; or levels of hemoglobin and glomerular filtration rate at admission and discharge&#46; This trend persisted for pre-admission diagnoses of chronic obstructive pulmonary disease &#40;COPD&#41;&#44; cerebrovascular disease&#44; diabetes&#44; heart failure&#44; or ischemic heart disease &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Survival analysis conducted through the Kaplan&#8211;Meier technique revealed elevated mortality rates at 1&#44; 2&#44; and 5 years among patients with delirium &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> and <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; Further analysis via Cox regression survival analysis indicated that factors contributing to the association between delirium and mortality included male gender&#44; advanced age&#44; presence of a cardiac event upon admission&#44; Cumulative Illness Rating Scale for Geriatrics &#40;CIRS-G&#41; score&#44; and the highest recorded score on the CONUT index&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Discussion</span><p id="par0070" class="elsevierStylePara elsevierViewall">In this study&#44; the history of dementia and chronic renal failure&#44; as well as a higher scores on the CIRS-G and CONUT index were related to delirium&#46; Additionally&#44; delirium was correlated with an increased number of admission complications&#44; particularly cardiac complications&#44; anemia and urinary tract infections&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Several studies have underscored the association between delirium and factors such as dementia&#44; medical comorbidities&#44; and postoperative complications including urinary tract infections and pneumonia&#44; all of which heighten the risk of delirium occurrence&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">12</span></a> In fact&#44; malnutrition and previous functional dependency have been implicated in increasing both morbidity and mortality rates among patients&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">These results could be explained thanks to the relationship between the pathophysiological mechanisms of delirium&#58; the neurotransmitter chemical alterations&#44; inflammatory storm and chronic stress&#46; Some studies has pointed to a lack of cholinergic activity&#44; due to high dopamine levels<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">8</span></a> and alterations in melatonina&#44; serotonin&#44; histamine&#44; norepinephine or glutamate release&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">9</span></a> The loss of brain functional reserve decreases the cerebral blood flow and the number of neurotransmitters&#44; this added to neurological stress cause by an infection or a metabolic alteration could development delirium&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">6&#44;8&#44;9</span></a> Inflammation state may cause delirium by way of stress-induced cytokines and microglial reactivity&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">9</span></a> Additional&#44; physical stress &#40;pain&#44; blood loss&#44; tissue damage&#41; stimulates interleukins secretion which produce changes in the permeability of blood- brain barrier<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">6</span></a>&#59; other stressors like hipoxia&#44; extremes in temperatura&#44; glucosa levels&#44; electrolyte and direct injury &#40;stroke or trauma&#41; may also disrupt neuronal activity&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">9</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">In addition&#44; we report that patients with delirium exhibited prolonged hospital stays and elevated short-&#44; medium-&#44; and long-term mortality rates compared to those without delirium&#46; These findings are consistent with previous research conducted at our center&#44; which identified delirium as a predictor of poorer functional recovery and elevated long-term mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">13</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Delirium was significantly associated with advanced age and male gender&#46; Advanced age emerges as a significant risk factor for delirium&#44; with individuals aged over 71 years exhibiting a threefold increased risk of delirium development&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">15</span></a> Moreover&#44; while hip fractures are more prevalent in women&#44; postoperative delirium is more frequently observed in men&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">12</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">The prevalence of delirium found was 11&#37;&#46; Previous literature in other populations has reported varying prevalence rates&#44; influenced by factors such as the type of population&#44; location&#44; setting&#44; and age&#46; For example&#44; the prevalence of postoperative delirium among nonagenarians with hip fractures is reported to be 28&#46;1&#37;&#44;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">4</span></a> in patients aged 85 years 36&#46;5&#37;&#44;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">5</span></a> and in younger patients&#44; around 76 years&#44; 17&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">14</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">The main limitations of the study are its retrospective design&#44; which includes the typical biases associated with the recruitment of data from medical records&#46; There was limited information on functional status and dementia severity&#44; which could be confounding factors&#46; Additionally&#44; there might be an underdiagnosis of hypoactive delirium&#46; Moreover&#44; the data recorded by doctors and nurses may not reflect the most accurate information to confidently apply the 4AT&#44; potentially leading to an underestimation of the true delirium incidence&#46; The measures used to prevent delirium within orthogeriatric care could also be related to the reported lower prevalence when compared to the available literature&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">The main strengths are the five-year follow-up carried out on the subgroup that reached that period&#44; and the sample size obtained in a group of patients with similar characteristics&#46; This study was conducted in a real-world hospital setting&#44; the study&#39;s findings reflect a typical clinical environment&#44; enhancing the external validity of the results&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">In conclusion&#44; delirium is associated to pathologies and complications&#44; which have an impact in patient hospitalization&#44; some of these are potentially preventable like nutritional deterioration&#44; worsening of anemia severity&#44; urinary tract infection after urinary catheterization and adequate intravenous hydration to avoid cardiac complication due to fluid overload&#46; For these reasons&#44; an early identification and treatment of these factors joined to an early diagnosis of delirium could decrease the mortality in older adults with hospital admission by hip fracture&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflict of interest</span><p id="par0115" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest&#46;</p></span></span>"
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              "identificador" => "sec0015"
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          "titulo" => "Results"
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    "fechaRecibido" => "2024-04-10"
    "fechaAceptado" => "2024-09-10"
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            0 => "Delirium"
            1 => "Hip fracture"
            2 => "Mortality"
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            0 => "<span class="elsevierStyleItalic">Delirium</span>"
            1 => "Fractura de cadera"
            2 => "Mortalidad"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hip fractures are a common pathology among older adults&#44; often accompanied by significant complications such as delirium&#44; a geriatric syndrome associated with prolonged hospitalization&#44; reduced functional recovery&#44; and decreased overall survival rates&#46; This study aims to determine the incidence of delirium and its correlation with various factors during hospitalization&#44; as well as its impact on short-&#44; medium-&#44; and long-term survival&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methodology</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A retrospective cohort study was undertaken to examine hospital admissions of individuals aged 70 years or older diagnosed with hip fractures at the Hospital Universitario La Ribera in Alzira&#44; Valencia&#44; from January 2012 to December 2021&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A total of 3226 patients were recruited&#44; mean of 85 years&#44; 73&#46;7&#37; females&#44; 26&#46;3&#37; males&#46; Delirium was observed in 10&#46;9&#37; of patients during hospitalization &#40;68&#46;8&#37; females&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;029&#41;&#46; Patients diagnosed with delirium exhibited a greater prevalence of dementia &#40;25&#46;2&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; and chronic kidney disease &#40;14&#46;7&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;018&#41;&#46; Delirium was also significantly associated with older age &#40;mean 86&#46;5 years &#91;SD 5&#46;6&#93;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#44; increased number of complications &#40;mean 1&#46;4 &#91;SD 1&#46;6&#93;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#44; cardiac complications &#40;9&#46;1&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;036&#41;&#44; anemia &#40;21&#46;7&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#44; and urinary tract infections &#40;7&#46;4&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; during hospitalization&#46; Furthermore&#44; patients with delirium experienced a prolonged hospital stay &#40;mean 9 vs&#46; 7&#46;9 days&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; and significantly higher short-&#44; medium-&#44; and long-term mortality rates&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Discussion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The study findings underscore a significant association between delirium and comorbidities&#44; complications&#44; and mortality&#46; Early identification of patients at risk for delirium will allow us to implement targeted interventions focused on prevention to enhance patient outcomes&#46;</p></span>"
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            "titulo" => "Introduction"
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            "titulo" => "Results"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La fractura de cadera es una afecci&#243;n com&#250;n en los adultos mayores&#44; que se relaciona con un incremento de complicaciones como el <span class="elsevierStyleItalic">delirium</span>&#44; un s&#237;ndrome geri&#225;trico asociado a una mayor estancia hospitalaria&#44; peor recuperaci&#243;n funcional y menor supervivencia&#46; El objetivo del estudio es determinar la incidencia de <span class="elsevierStyleItalic">delirium</span> y su correlaci&#243;n con diversos factores durante la hospitalizaci&#243;n&#44; como su impacto en la supervivencia a corto&#44; mediano y largo plazo&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Metodolog&#237;a</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se dise&#241;&#243; un estudio de cohorte retrospectiva con los ingresos hospitalarios de adultos de edad igual o superior a 70 a&#241;os&#44; con diagn&#243;stico de fractura de cadera efectuados en el Hospital Universitario La Ribera &#40;Alzira&#44; Valencia&#41; desde enero de 2012 a diciembre de 2021&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se reclutaron 3&#46;226 pacientes&#44; con edad media de 85 a&#241;os&#44; el 73&#44;7&#37; mujeres y el 26&#44;3&#37; varones&#46; El 10&#44;9&#37; de los pacientes present&#243; <span class="elsevierStyleItalic">delirium</span> durante la hospitalizaci&#243;n &#40;68&#44;8&#37; mujeres&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;029&#41;&#46; Los pacientes con <span class="elsevierStyleItalic">delirium</span> presentaron mayor prevalencia de demencia &#40;25&#44;2&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; y enfermedad renal cr&#243;nica &#40;14&#44;7&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;018&#41;&#46; Asimismo&#44; el <span class="elsevierStyleItalic">delirium</span> se asoci&#243; significativamente a mayor edad &#40;media&#58; 86&#44;5 a&#241;os &#91;DE&#58; 5&#44;6&#93;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; n&#250;mero de complicaciones &#40;media&#58; 1&#44;4 &#91;DE&#58; 1&#44;6&#93;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; complicaciones cardiacas &#40;9&#44;1&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;&#46;036&#41;&#44; anemia &#40;21&#44;8&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; e infecciones de tracto urinario &#40;7&#44;4&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; durante la hospitalizaci&#243;n&#46; Aquellos con <span class="elsevierStyleItalic">delirium</span> tuvieron mayor estancia hospitalaria &#40;9 vs&#46; 7&#44;9 d&#237;as&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; como mayor mortalidad a corto&#44; medio y largo plazo&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Discusi&#243;n</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El estudio muestra una asociaci&#243;n significativa entre la presencia de <span class="elsevierStyleItalic">delirium</span>&#44; y comorbilidades&#44; complicaciones y mortalidad&#46; El identificar tempranamente a los pacientes con riesgo de <span class="elsevierStyleItalic">delirium</span>&#44; nos permitir&#225; implementar acciones preventivas para mejorar la recuperaci&#243;n de nuestros pacientes&#46;</p></span>"
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                  \t\t\t\t"><span class="elsevierStyleItalic">Initial hemoglobin &#40;mg&#47;dl&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Initial glomerular filtration &#40;ml&#47;min&#47;1&#46;73</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">m</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Final glomerular filtration &#40;ml&#47;min&#47;1&#46;73</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">m</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">&#41;</span>&nbsp;\t\t\t\t\t\t\n
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          "identificador" => "bibs0015"
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            0 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ageing and health &#91;Internet&#93;"
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                          "colaboracion" => "World Health Organization"
                          "etal" => false
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                0 => array:1 [
                  "referenciaCompleta" => "European Commission&#46; Report on osteoporosis in the European Community-Action for prevention&#46; Manuscript completed in 1998&#46; Available from&#58; <a target="_blank" href="https://www.osteoporosis.foundation/sites/iofbonehealth/files/201906/1998_EU_Report_ActionForPrevention_English.pdf">https&#58;&#47;&#47;www&#46;osteoporosis&#46;foundation&#47;sites&#47;iofbonehealth&#47;files&#47;201906&#47;1998&#95;EU&#95;Report&#95;ActionForPrevention&#95;English&#46;pdf</a>&#46;"
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              "identificador" => "bib0090"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Una revisi&#243;n orientada a la pr&#225;ctica cl&#237;nica"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "Z&#46; Ganuza"
                            1 => "M&#46; Gonz&#225;lez"
                            2 => "M&#46; Gaviria"
                            3 => "E&#46;l&#46; Delirium"
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4321/S0211-57352012000200003"
                      "Revista" => array:5 [
                        "tituloSerie" => "Rev Asoc Esp Neuropsiq"
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                        "volumen" => "32"
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                        "paginaFinal" => "259"
                      ]
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              "identificador" => "bib0095"
              "etiqueta" => "4"
              "referencia" => array:1 [
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                      "titulo" => "Risk factors and prognosis of postoperative delirium in nonagenarians with hip fracture"
                      "autores" => array:1 [
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                          "etal" => false
                          "autores" => array:5 [
                            0 => "S&#46; Zhao"
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                            2 => "J&#46; Zhang"
                            3 => "X&#46; Chen"
                            4 => "X&#46; Wang"
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                  "host" => array:1 [
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                      "doi" => "10.1038/s41598-023-27829-4"
                      "Revista" => array:5 [
                        "tituloSerie" => "Sci Rep"
                        "fecha" => "2023"
                        "volumen" => "13"
                        "paginaInicial" => "2167"
                        "link" => array:1 [
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/36750657"
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