Oral Papers: Neuropsychiatry
Catatonia, Delirium and Coma: Implications for Mortality
Background / Significance: Delirium, a form of acute brain dysfunction, characterized by changes in attention and alertness, is a known independent predictor of mortality in the Intensive Care Unit (ICU). We sought to understand whether catatonia, a more recently recognized form of acute brain dysfunction in critical illness, is associated with increased in hospital mortality in critically ill adults.
Methods: We prospectively enrolled critically ill patients at a single institution who were on a ventilator or in shock and evaluated them daily for catatonia using the Bush Francis Catatonia Rating Scale and delirium using the Confusion Assessment for the ICU. Coma was defined as a Richmond Agitation Scale score of -4 or -5. We used the Cox Proportional Hazards model predicting time to in hospital mortality after adjusting for delirium, coma and catatonia status.
Results: We enrolled 335 medical, surgical or trauma critically ill patients with 1103 matched delirium and catatonia assessments. Median age was 58 years (95% Confidence Interval (CI): 48 - 67). Main indications for admission to the ICU included: airway disease or protection (32%; N=100) or sepsis and/or shock (25%; N=79). For DSM-5 catatonia scores, a 1-unit increase in the score was associated with 1.18 times the hazards of in hospital mortality. Comparing non-delirious individuals, holding catatonia status constant, delirious individuals have 1.72 times the hazards of death (95% CI: 1.321, 2.231) while those with coma have 5.48 times the hazards of death (95% CI: 4.298, 6.984). Comparing two individuals with the same delirium status, an individual with a DSM-5 catatonia score of 0 (no catatonia) will have 1.178 times the hazard of death (95% CI: 1.086, 1.278), while an individual with a score of 3 catatonia items (catatonia) present will have 1.63 times the hazard of death. Fully adjusted model results (for baseline and daily covariates) are pending at the time of submission. Full model results are expected to be completed by the end of April 2019.
Discussion: Comparing the absence and presence of catatonia, the presence of catatonia seems to worsen survival. Those individual who are both comatose and catatonic have the lowest median survival time. Non-delirious individuals have the highest median survival times, while those who are comatose, holding catatonia status constant have the lowest median survival times.
Conclusion: The presence of catatonia in the context of critical illness may be associated with decreased in hospital survival. Fully adjusted model results are pending.