Reversibility of delirium in Ill-hospitalized cancer patients: Does underlying etiology matter?
Reversibility of delirium in Ill-hospitalized cancer patients: Does underlying etiology matter?
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DOI：
10.1002/cam4.2669
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发表时间：
2019-11-06
期刊：
影响因子：
4
通讯作者：
Yokomichi, Naosuke
中科院分区：
文献类型：
--
作者：
Matsuda, Yoshinobu;Maeda, Isseki;Yokomichi, Naosuke
背景：本研究的目的是探讨与住院不良癌症患者谵妄消退和改善相关的潜在病因。方法我们对一项多中心、前瞻性、观察性研究进行了二次分析，以评估药物治疗谵妄的有效性。参与者是患有谵妄的癌症患者。我们评估了基线和药物治疗开始后3天的谵妄评定量表修订版-98（DRS-R98）严重程度量表评分。谵妄消退定义为第3天DRS-R98严重程度量表评分降低≥ 50%。结果我们纳入了566例患者（491例患者的体能状态为3或4）。所有患者的缓解率和改善率分别为22.6%和19.3%。单因素分析确定非呼吸道感染（OR 2.18，95% CI 1.38-3.45）与更高的分辨率显著相关，而脱水（0.40，0.19-0.87），中枢神经系统（CNS）的器质性损害（0.32，0.43-0.72）、缺氧（0.25，0.12-0.52）和低钠血症（0.34，0.12-0.97）与无缓解显著相关。与谵妄改善相关的潜在原因为非呼吸道感染（1.93，1.19-3.13）、CNS器质性损伤（0.40，0.18-1.90）和缺氧（0.32，0.16-0.65）。多变量分析后，脱水（0.34，0.15-0.76）、中枢神经系统器质性损伤（0.25，0.10-0.60）和缺氧（0.29，0.14-0.61）与未消退显著相关。结论非呼吸道感染引起的谵妄可能是可逆的，而在住院的恶性肿瘤患者中，与脱水、CNS器质性损害、缺氧或低钠血症相关的谵妄似乎是不可逆的。
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 = 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.