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

on behalf of the Phase-R Delirium Study Group

Research output: Contribution to journalArticle

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.

Original languageEnglish
JournalCancer Medicine
DOIs
Publication statusAccepted/In press - 2019 Jan 1

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Delirium
Neoplasms
Central Nervous System
Dehydration
Hyponatremia
Infection
Drug Therapy
Observational Studies
Multivariate Analysis
Prospective Studies
Hypoxia

Keywords

  • cancer
  • cause
  • delirium
  • palliative care
  • reversibility

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

Cite this

Reversibility of delirium in Ill-hospitalized cancer patients : Does underlying etiology matter? / on behalf of the Phase-R Delirium Study Group.

In: Cancer Medicine, 01.01.2019.

Research output: Contribution to journalArticle

@article{07905fc6dc2440fca424a17fa7f2bc6b,
title = "Reversibility of delirium in Ill-hospitalized cancer patients: Does underlying etiology matter?",
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",
author = "{on behalf of the Phase-R Delirium Study Group} and Yoshinobu Matsuda and Isseki Maeda and Tatsuya Morita and Toshihiro Yamauchi and Akihiro Sakashita and Hiroaki Watanabe and Keisuke Kaneishi and Koji Amano and Satoru Iwase and Asao Ogawa and Kazuhiro Yoshiuchi and Hirofumi Abo and Tatsuo Akechi and Nobuya Akizuki and Toru Okuyama and Daisuke Fujisawa and Shingo Hagiwara and Takeshi Hirohashi and Takayuki Hisanaga and Kengo Imai and Shuji Inada and Satoshi Inoue and Shinichiro Inoue and Aio Iwata and Akifumi Kumano and Takashi Matsui and Yoshihisa Matsumoto and Naoki Matsuo and Kaya Miyajima and Ichiro Mori and Sachiyo Morita and Rika Nakahara and Nobuhisa Nakajima and Hiroyuki Nobata and Takuya Odagiri and Ken Shimizu and {Sumazaki Watanabe}, Yuki and Keita Tagami and Emi Takeuchi and Mari Takeuchi and Ryohei Tatara and Akihiro Tokoro and Megumi Uchida and Keiichi Uemura and Ritsuko Yabuki and Naosuke Yokomichi",
year = "2019",
month = "1",
day = "1",
doi = "10.1002/cam4.2669",
language = "English",
journal = "Cancer Medicine",
issn = "2045-7634",
publisher = "John Wiley and Sons Ltd",

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TY - JOUR

T1 - Reversibility of delirium in Ill-hospitalized cancer patients

T2 - Does underlying etiology matter?

AU - on behalf of the Phase-R Delirium Study Group

AU - Matsuda, Yoshinobu

AU - Maeda, Isseki

AU - Morita, Tatsuya

AU - Yamauchi, Toshihiro

AU - Sakashita, Akihiro

AU - Watanabe, Hiroaki

AU - Kaneishi, Keisuke

AU - Amano, Koji

AU - Iwase, Satoru

AU - Ogawa, Asao

AU - Yoshiuchi, Kazuhiro

AU - Abo, Hirofumi

AU - Akechi, Tatsuo

AU - Akizuki, Nobuya

AU - Okuyama, Toru

AU - Fujisawa, Daisuke

AU - Hagiwara, Shingo

AU - Hirohashi, Takeshi

AU - Hisanaga, Takayuki

AU - Imai, Kengo

AU - Inada, Shuji

AU - Inoue, Satoshi

AU - Inoue, Shinichiro

AU - Iwata, Aio

AU - Kumano, Akifumi

AU - Matsui, Takashi

AU - Matsumoto, Yoshihisa

AU - Matsuo, Naoki

AU - Miyajima, Kaya

AU - Mori, Ichiro

AU - Morita, Sachiyo

AU - Nakahara, Rika

AU - Nakajima, Nobuhisa

AU - Nobata, Hiroyuki

AU - Odagiri, Takuya

AU - Shimizu, Ken

AU - Sumazaki Watanabe, Yuki

AU - Tagami, Keita

AU - Takeuchi, Emi

AU - Takeuchi, Mari

AU - Tatara, Ryohei

AU - Tokoro, Akihiro

AU - Uchida, Megumi

AU - Uemura, Keiichi

AU - Yabuki, Ritsuko

AU - Yokomichi, Naosuke

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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.

AB - 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.

KW - cancer

KW - cause

KW - delirium

KW - palliative care

KW - reversibility

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DO - 10.1002/cam4.2669

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AN - SCOPUS:85074865288

JO - Cancer Medicine

JF - Cancer Medicine

SN - 2045-7634

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