High proportion of thiamine deficiency in referred cancer patients with delirium: a retrospective descriptive study

Hideki Onishi,Takao Takahashi,Akira Yoshioka,Daisuke Furuya,Izumi Sato,Nozomu Uchida,Yasuhiro Ebihara,Mayumi Ishida,Hiroshi Ito

doi:10.1038/s41430-021-00859-9

Abstract

Background/ObjectivesRecent studies have revealed thiamine deficiency (TD) as a cause of delirium in cancer patients. However, the extent to which Wernicke encephalopathy is present and in what patients is not well understood.Subjects/MethodsIn this retrospective descriptive study, we investigated referred cancer patients who were diagnosed with delirium by a psycho-oncologist to clarify the proportion of TD, the therapeutic effect of thiamine administration, and the factors involved in its onset.ResultsAmong 71 patients diagnosed with delirium by a psycho-oncologist, TD was found in 45% of the patients. Intravenous administration of thiamine led to a recovery in about 60% of these patients. We explored the factors associated with TD using a multivariable regression model with a Markov chain Monte Carlo imputation procedure. We found an association between TD and chemotherapy (adjusted odds ratio, 1.98 [95% confidence interval, 1.04–3.77]); however, there were no significant associations between TD and the other factors we considered.ConclusionsTD is not particularly rare in delirium patients undergoing psychiatric consultation. The delirium was resolved in more than half of these patients by intravenous administration of thiamine. Oncologists should consider TD as a cause of delirium in cancer patients. Further prospective study is needed to clarify the relationship between TD and delirium in cancer patients.

Highlights

Delirium is one of the major problems arising during the course of cancer treatment
We collected data regarding each patient’s background, history of cancer treatment [radiation/chemotherapy/surgery/hormone] within 2 months from the time of blood sampling for vitamin B1 measurement, and disappearance of the symptoms of delirium after vitamin B1 treatment from electronic medical records (EMRs), and results of laboratory examinations, which were ordered as part of routine clinical care based on the judgment of the treating physicians at the time of referral or within a few days before consultation
In this retrospective descriptive study, we clarified the percentage of cancer patients with delirium who experienced thiamine deficiency (TD) as well as the patients’ background characteristics

Summary

Introduction

Delirium is one of the major problems arising during the course of cancer treatment As this condition is common in patients with advanced cancer and is associated with increased complications and mortality, an examination of its causes in its early stages as well as therapeutic interventions is required [1]. A typical neuropsychiatric disorder associated with TD is Wernicke encephalopathy (WE), which is recognized by a classic triad of symptoms: mental status changes, ataxia, and ocular symptoms This disease was previously seen as a common illness associated with alcoholism, but it can develop in association with any disease resulting in a loss of appetite [17]. In cancer patients with delirium, early detection and treatment of TD is an important issue for preventing severe brain damage, such as that associated with Korsakoff syndrome, and maintaining the patient quality of life. We undertook this retrospective descriptive study of referred cancer patients who developed delirium, focusing on the proportion of those with TD and their characteristics

Study design and setting

Results

Discussion

Compliance with ethical standards