Phenomenology of delirium in decompensated liver disease patients-a prospective observational study

Abstract

Background: Decompensated liver disease (DCLD) is associated with various cognitive changes. The present study aimed to estimate the prevalence, phenomenology, and course of delirium in decompensated liver disease patients. Methods: This prospective observational study was done on 111 patients admitted to the gastroenterology department with the diagnosis of DCLD. Richmond Agitation Sedation Scale (RASS) and confusion assessment method (CAM) were used to detect delirium for the first five consecutive days. Patients detected to be having delirium were administered a delirium rating scale (DRS) for the next seven days to evaluate the features of delirium. Descriptive analysis was carried out by mean and standard deviation for quantitative variables, frequency, and proportion for categorical variables. For normally distributed quantitative parameters, the mean values were compared using an independent sample t-test. Categorical outcomes were compared between study groups using the chi-square test. coGuide version V.1.0 was used for statistical analysis. Results: The prevalence of delirium among patients with DCLD was 34 (30.63%). All delirious patients continued to have delirium symptoms for the initial three days. Six patients remitted as early as the fourth day of DRS assessment, while nine patients continued to have delirium symptoms even by the seventh day of evaluation. Conclusion: Nearly one-third of patients with DCLD presented with delirium. They presented with insomnia, cognitive deficits, motor retardation, and minimal psychotic symptoms. Many patients completely recovered from delirium within a week, but a few had delirium up to the seventh day.

Keywords

• delirium
• hepatitis
• hepatic encephalopathy
• cirrhosis