Abstract
BackgroundAlthough the association between polypharmacy and the occurrence of delirium has been well studied, the influence of polypharmacy on the persistence of delirium remains unclear. We aimed to explore the effect of polypharmacy on the persistence of delirium.MethodsThis retrospective cohort study was conducted at a tertiary hospital. The medical records of patients diagnosed with delirium who were referred to the Department of Psychosomatic Medicine were reviewed. Presentation with delirium on day 3 was set as the outcome in this study. We counted the number of drugs prescribed on the date of referral, excluding general infusion fluids, nutritional or electrolytic products, and psychotropics. To define polypharmacy, we developed a classification and regression tree (CART) model and drew a receiver operating characteristic (ROC) curve. The odds ratio (OR) of polypharmacy for the persistence of delirium on day 3 was calculated using a logistic regression model with the propensity score as a covariate.ResultsWe reviewed the data of 113 patients. The CART model and ROC curve indicated an optimal polypharmacy cutoff of six drugs. Polypharmacy was significantly associated with the persistence of delirium both before [OR, 3.02; 95% confidence interval (CI), 1.39–6.81; P = 0.0062] and after (OR, 3.19; 95% CI, 1.32–8.03; P = 0.011) propensity score adjustment.ConclusionWe discovered an association between polypharmacy and worsening courses of delirium and hypothesize that polypharmacy might be a prognostic factor for delirium.
Highlights
The association between polypharmacy and the occurrence of delirium has been well studied, the influence of polypharmacy on the persistence of delirium remains unclear
We reviewed the medical records of patients (a) who had been suspected to have any psychiatric disorder by physicians in departments other than the Department of Psychosomatic Medicine, (b) who had been referred to the Department of Psychosomatic Medicine from March 2019 to October 2019, (c) who had been diagnosed with delirium, and (d) who had not been under continuous sedation
The kappa statistic for a delirium evaluation was 0.66 (95% confidence interval [CI] = 0.53–0.80), which showed a substantial degree of reproducibility
Summary
The association between polypharmacy and the occurrence of delirium has been well studied, the influence of polypharmacy on the persistence of delirium remains unclear. Inappropriate prescribing practices mainly contribute to its occurrence [2, 3]. It causes both physiological and psychological problems for patients with multiple morbidities [4, 5]. The association between polypharmacy and the incidence of delirium has been well studied [6,7,8,9,10] and a guideline recommends drug reviews for delirium prevention [11]. The influence of polypharmacy on the persistence of delirium has yet to be examined thoroughly. One retrospective study investigated the effect of Kurisu et al BioPsychoSocial Medicine (2020) 14:25 a drug review on the course of delirium treatment, but did not focus on the effect of the number of drugs [12]
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