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Observational Study
. 2020 Jan;9(1):19-26.
doi: 10.1002/cam4.2669. Epub 2019 Nov 6.

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

Yoshinobu Matsuda  1 , Isseki Maeda  2 , Tatsuya Morita  3 , Toshihiro Yamauchi  4 , Akihiro Sakashita  5 , Hiroaki Watanabe  6 , Keisuke Kaneishi  7 , Koji Amano  8 , Satoru Iwase  9 , Asao Ogawa  10 , Kazuhiro Yoshiuchi  11 ; Phase-R Delirium Study Group
Collaborators, Affiliations
Observational Study

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

Yoshinobu Matsuda et al. Cancer Med. 2020 Jan.

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.

Keywords: cancer; cause; delirium; palliative care; reversibility.

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Conflict of interest statement

All authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Resolution or improvement rates of the causes of delirium. Abbreviations: DIC, disseminated intravascular coagulation. Error bars indicate 95% confidence intervals
See this image and copyright information in PMC

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