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

Cancer Medicine

on behalf of the Phase‐R Delirium Study Group¹  Hiroaki Watanabe²  Keisuke Kaneishi³  Akihiro Sakashita⁴  Koji Amano⁵  Satoru Iwase⁶  Yoshinobu Matsuda⁷  Asao Ogawa⁸  Kazuhiro Yoshiuchi⁹  Isseki Maeda^1,10  Tatsuya Morita^1,11  Toshihiro Yamauchi^1,12 

[1] ;Department of Palliative Care Komaki City Hospital Aichi Japan;Department of Palliative Care Unit JCHO Tokyo Shinjuku Medical Center Tokyo Japan;Department of Palliative Medicine Kobe University Graduate School of Medicine Hyogo Japan;Department of Palliative Medicine Osaka City General Hospital Osaka Japan;Department of Palliative Medicine Saitama Medical University Saitama Japan;Department of Psychosomatic Internal Medicine National Hospital Organization Kinki‐Chuo Chest Medical Center Osaka Japan;Department of Psycho‐Oncology Exploratory Oncology Research and Clinical Trial Center National Cancer Center Chiba Japan;Department of Stress Science and Psychosomatic Medicine Graduate School of Medicine The University of Tokyo Tokyo Japan;Gratia Hospice Gratia Hospital Osaka Japan;Palliative and Supportive Care Division Seirei Mikatahara General Hospital Shizuoka Japan;Seirei Hospice Seirei Mikatahara General Hospital Shizuoka Japan;

关键词: cancer;    cause;    delirium;    palliative care;    reversibility;   

DOI  :  10.1002/cam4.2669

来源: DOAJ

【 摘 要 】

Abstract Background The objective of this study was to explore the underlying etiologies associated with the resolution and improvement of delirium in ill‐hospitalized cancer patients. Methods We 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. Results We 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. Conclusions Delirium 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.

【 授权许可】

Unknown