Anticholinergic drug exposure at intensive care unit admission affects the occurrence of delirium. A prospective cohort study

Vondeling, Ariël M.; Knol, Wilma; Egberts, Toine C. G.; Slooter, Arjen J. C.

doi:10.1016/j.ejim.2020.04.062

Cited by 11 publications

(19 citation statements)

References 42 publications

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“…Previous cohort studies investigated the association of seven ABSs with delirium. 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 While the ARS and DS showed an association with delirium in all previous studies, 41 , 43 , 44 , 47 , 48 the ACB and ADS demonstrated contradicting results. 40 , 42 , 44 , 50 , 51 , 52 The Chew, CrAS and SCDL have so far not been associated with delirium.…”

Section: Discussionmentioning

confidence: 74%

“…[40][41][42][43][44][45][46][47][48][49][50][51][52] While the ARS and DS showed an association with delirium in all previous studies, 41,43,44,47,48 the ACB and ADS demonstrated contradicting results. 40,42,44,[50][51][52] The Chew, CrAS and SCDL have so far not been associated with delirium. [44][45][46] However, not all of these studies can be compared to ours.…”

Section: Discussionmentioning

confidence: 75%

“…Previous cohort studies investigated the association of seven ABSs with delirium 40–52 . While the ARS and DS showed an association with delirium in all previous studies, 41,43,44,47,48 the ACB and ADS demonstrated contradicting results 40,42,44,50–52 . The Chew, CrAS and SCDL have so far not been associated with delirium 44–46 .…”

Section: Discussionmentioning

confidence: 94%

“… 44 , 45 , 46 However, not all of these studies can be compared to ours. Wolters et al, 48 Burry et al, 41 Rigor et al 51 and Vondeling et al, 52 investigating the ADS, ARS, DS and ACB, studied delirium in ICU patients, which were excluded from this report. Egberts et al, 44 evaluating the ACB, ARS and Chew, focused on delirium at hospital admission, which was also excluded from our study.…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of the association of anticholinergic burden and delirium in older hospitalised patients – A cohort study comparing 19 anticholinergic burden scales

Lisibach

Gallucci

Benelli

et al. 2022

Brit J Clinical Pharma

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A recent review identified 19 anticholinergic burden scales (ABSs) but no study has yet compared the impact of all 19 ABSs on delirium. We evaluated whether a high anticholinergic burden as classified by each ABS is associated with incident delirium. Method:We performed a retrospective cohort study in a Swiss tertiary teaching hospital using data from 2015-2018. Included were patients aged ≥65, hospitalised ≥48 hours with no stay >24 hours in intensive care. Delirium was defined twofold:(i) ICD-10 or CAM and (ii) ICD-10 or CAM or DOSS. Patients' cumulative anticholinergic burden score, calculated within 24 hours after admission, was classified using a binary (<3: low, ≥3: high burden) and a categorical approach (0: no, 0.5-3: low, ≥3: high burden). Association was analysed using multivariable logistic regression.Results: Over 25 000 patients (mean age 77.9 ± 7.6 years) were included. Of these, (i) 864 (3.3%) and (ii) 2770 (11.0%) developed delirium. Depending on the evaluated ABS, 4-63% of the patients were exposed to at least one anticholinergic drug. Out of 19 ABSs, (i) 14 and (ii) 16 showed a significant association with the outcomes. A patient with a high anticholinergic burden score had odds ratios (ORs) of 1.21 (95% confidence interval [CI]: 1.03-1.42) to 2.63 (95% CI: 2.28-3.03) for incident delirium compared to those with low or no burden. Conclusion:A high anticholinergic burden within 24 hours after admission was significantly associated with incident delirium. Although prospective studies need to confirm these results, discontinuing or substituting drugs with a score of ≥3 at admission might be a targeted intervention to reduce incident delirium.

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Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 75%

Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Evaluation of the association of anticholinergic burden and delirium in older hospitalised patients – A cohort study comparing 19 anticholinergic burden scales

Lisibach

Gallucci

Benelli

et al. 2022

Brit J Clinical Pharma

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“…Of 315 included studies, including 101 144 patients (50 006 [50.0%] male and 49 766 [49.1%] female patients; 24 015 patients with delirium), date of publication spanned 29 years, from 1992 to 2021 (Table 1). Studies were conducted in 40 different countries, with the plurality in the United States (86 studies 17-22,28,29,32,37,44,46,54,55,61,66,81,82,84,102,103,106,113,115,116,118,120,125,126,129,136, 138,140,142,143,147-150,161-163,173,175-179,187,188,191-193,199,201,202,208,210,215,216,220,222-224,228,235,238,242,246-248, 251,252,254,257,261,262,273,275,280,282,295-297,308,317 [27.3%]), followed by China (48 studies 23,40,78,85-88, 114,117,130,132,133,137,141,166,181,182,184,185,189,190,204-206,217,230,236,237,243,255,276,281,303-307,316,318-320,322,324-329 [15.2%]) and the Netherlands (24 studies 48,63,67,70,100,110,111,128,154,167,264,265,287,288,[290][291][292][293][294]301,311,313,314,323 [7.6%]). Most studies were prospective cohort studies (296 studies [49][50][51][53][54][55][56]58,59,61,[63][64][65][66]…”

Section: Study Characteristicsmentioning

confidence: 99%

Predisposing and Precipitating Factors Associated With Delirium

et al. 2023

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ImportanceDespite discrete etiologies leading to delirium, it is treated as a common end point in hospital and in clinical trials, and delirium research may be hampered by the attempt to treat all instances of delirium similarly, leaving delirium management as an unmet need. An individualized approach based on unique patterns of delirium pathophysiology, as reflected in predisposing factors and precipitants, may be necessary, but there exists no accepted method of grouping delirium into distinct etiologic subgroups.ObjectiveTo conduct a systematic review to identify potential predisposing and precipitating factors associated with delirium in adult patients agnostic to setting.Evidence ReviewA literature search was performed of PubMed, Embase, Web of Science, and PsycINFO from database inception to December 2021 using search Medical Subject Headings (MeSH) terms consciousness disorders, confusion, causality, and disease susceptibility, with constraints of cohort or case-control studies. Two reviewers selected studies that met the following criteria for inclusion: published in English, prospective cohort or case-control study, at least 50 participants, delirium assessment in person by a physician or trained research personnel using a reference standard, and results including a multivariable model to identify independent factors associated with delirium.FindingsA total of 315 studies were included with a mean (SD) Newcastle-Ottawa Scale score of 8.3 (0.8) out of 9. Across 101 144 patients (50 006 [50.0%] male and 49 766 [49.1%] female patients) represented (24 015 with delirium), studies reported 33 predisposing and 112 precipitating factors associated with delirium. There was a diversity of factors associated with delirium, with substantial physiological heterogeneity.Conclusions and RelevanceIn this systematic review, a comprehensive list of potential predisposing and precipitating factors associated with delirium was found across all clinical settings. These findings may be used to inform more precise study of delirium’s heterogeneous pathophysiology and treatment.

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Symptoms in Advanced Hematologic Malignancies and Other Serious Hematologic Conditions

Davis,

Fernandez,

Vithalani

et al. 2023

Palliative Care in Hematologic Malignancies and Serious Blood Disorders

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Anticholinergic drug exposure at intensive care unit admission affects the occurrence of delirium. A prospective cohort study

Cited by 11 publications

References 42 publications

Evaluation of the association of anticholinergic burden and delirium in older hospitalised patients – A cohort study comparing 19 anticholinergic burden scales

Evaluation of the association of anticholinergic burden and delirium in older hospitalised patients – A cohort study comparing 19 anticholinergic burden scales

Predisposing and Precipitating Factors Associated With Delirium

Symptoms in Advanced Hematologic Malignancies and Other Serious Hematologic Conditions

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