Reversibility of delirium in Ill-hospitalized cancer patients: Does underlying etiology matter?

Yoshinobu Matsuda,Keisuke Kaneishi,Hiroaki Watanabe,Asao Ogawa,Akihiro Sakashita,Kazuhiro Yoshiuchi,Tatsuya Morita,Toshihiro Yamauchi,Satoru Iwase,Koji Amano,Isseki Maeda

doi:10.1002/cam4.2669

Abstract

BackgroundThe objective of this study was to explore the underlying etiologies associated with the resolution and improvement of delirium in ill‐hospitalized cancer patients.MethodsWe conducted a secondary analysis of a multicenter, prospective, observational study to estimate the effectiveness of pharmacotherapy for delirium. Participants were cancer patients with delirium. We assessed the Delirium Rating Scale, Revised‐98 (DRS‐R98) severity scale score at baseline and three days after pharmacotherapy initiation. Delirium resolution was defined as a DRS‐R98 severity scale score ≤9, and improvement was defined as ≥50% reduction at Day 3.ResultsWe enrolled 566 patients (491 patients had performance status of 3 or 4). The resolution and improvement rates in all patients were 22.6% and 19.3%, respectively. Univariate analysis determined that nonrespiratory infection (OR 2.18, 95% CI 1.38‐3.45) was significantly associated with greater resolution, while dehydration (0.40, 0.19‐0.87), organic damage to the central nervous system (CNS) (0.32, 0.43‐0.72), hypoxia (0.25, 0.12‐0.52), and hyponatremia (0.34, 0.12‐0.97) were significantly associated with no resolution. Potential causes associated with delirium improvement were nonrespiratory infection (1.93, 1.19‐3.13), organic damage to the CNS (0.40, 0.18‐1.90), and hypoxia (0.32, 0.16‐0.65). After multivariate analysis, dehydration (0.34, 0.15‐0.76), organic damage to the CNS (0.25, 0.10‐0.60), and hypoxia (0.29, 0.14‐0.61) were significantly associated with no resolution.ConclusionsDelirium caused by nonrespiratory infection may be reversible, while delirium associated with dehydration, organic damage to the CNS, hypoxia, or hyponatremia seems to be irreversible in ill‐hospitalized cancer patients.

Highlights

Delirium is a common symptom in patients with cancer[1,2,3,4] and causes distress to both the affected patients and their families.[5,6] Delirium is associated with increased morbidity and mortality, and higher healthcare costs.[7,8] it is important to manage delirium in patients with cancer
Univariate analysis determined that nonrespiratory infection was significantly associated with greater resolution in the DRS‐R98 severity scale score, while dehydration, organic damage to the central nervous system (CNS), hypoxia, and hyponatremia were significantly associated with no resolution
Univariate analysis identified nonrespiratory infection as associated with significantly greater resolution in the DRS‐R98 severity scale score, whereas dehydration, organic damage to the CNS, hypoxia, and hyponatremia were associated with significantly no resolution

Summary

Introduction

Delirium is a common symptom in patients with cancer[1,2,3,4] and causes distress to both the affected patients and their families.[5,6] Delirium is associated with increased morbidity and mortality, and higher healthcare costs.[7,8] it is important to manage delirium in patients with cancer. Antipsychotics have been used to manage the symptoms of delirium in cancer patients.[9,10,11,12] a randomized clinical trial comparing antipsychotics to placebo in patients receiving palliative care revealed that the delirium symptom score was higher in the antipsychotic groups than in the placebo group, suggesting that management of the causes for delirium and supportive strategies may be more effective than administering antipsychotics.[13] Opioids, hypnotics, anxiolytics, corticosteroids, anticholinergic drugs, hypercalcemia, hyponatremia, dehydration, hypoxia, infection, and organic damage to the central nervous system (CNS) have been reported as causes of delirium.[14,15,16,17,18] One standard treatment for delirium is to identify and manage such underlying causes.[17] Knowledge of the reversibility of various causes of delirium is an important consideration in planning suitable treatment strategies for individual patients. Univariate analysis determined that nonrespiratory infection (OR 2.18, 95% CI 1.38‐3.45) was significantly associated with greater resolution, while dehydration (0.40, 0.19‐0.87), organic damage to the central nervous system (CNS) (0.32, 0.43‐0.72), hypoxia (0.25, 0.12‐0.52), and hyponatremia (0.34, 0.12‐0.97) were

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