Delirium is associated with an increased morbidity and in-hospital mortality in cancer patients: Results from a prospective cohort study

Abstract

Objective Delirium is a frequent complication in advanced cancer patients, among whom it is frequently underdiagnosed and inadequately treated. To date, evidence on risk factors and the prognostic impact of delirium on outcomes remains sparse in this patient population. Method In this prospective observational cohort study at a single tertiary-care center, 1,350 cancer patients were enrolled. Simple and multiple logistic regression models were utilized to identify associations between predisposing and precipitating factors and delirium. Cox proportional-hazards models were used to estimate the effect of delirium on death rate. Results In our patient cohort, the prevalence of delirium was 34.3%. Delirium was associated inter alia with prolonged hospitalization, a doubling of care requirements, increased healthcare costs, increased need for institutionalization (OR 3.22), and increased mortality (OR 8.78). Predisposing factors for delirium were impaired activity (OR 10.82), frailty (OR 4.75); hearing (OR 2.23) and visual impairment (OR 1.89), chronic pneumonitis (OR 2.62), hypertension (OR 1.46), and renal insufficiency (OR 1.82). Precipitating factors were acute renal failure (OR 7.50), pressure sores (OR 3.78), pain (OR 2.86), and cystitis (OR 1.32). On multivariate Cox regression, delirium increased the mortality risk sixfold (HR 5.66). Age ≥ 65 years and comorbidities further doubled the mortality risk of delirious patients (HR 1.77; HR 2.05). Significance of results Delirium is common in cancer patients and associated with increased morbidity and mortality. Systematically categorizing predisposing and precipitating factors might yield new strategies for preventing and managing delirium in cancer patients.

Profiling Delirium Progression in Elderly Patients via Continuous-Time Markov Multi-State Transition Models

“…Delirium has also been considered a factor influencing the risk of developing other new forms of dementia [ 23 ] and as a possible issue affecting the quality of life [ 24 ]. In these research studies, the statistical methods mostly used are linear regression [ 16 ] or Cox proportional hazard model (shortly Cox model) [ 16 , 21 , 22 ]. Such methods are relevant for understanding the problem of delirium and its consequences in terms of clinical outcomes.…”

“…These approaches are useful to investigate the magnitude of the problem in a specific ward and moment. Delirium is also considered as a risk factor for clinical outcomes such as mortality in several categories of subjects; for example, COVID-19 patients [19], vascular surgery patients [20], oncological [21], and critically ill adults [22]. Delirium has also been considered a factor influencing the risk of developing other new forms of dementia [23] and as a possible issue affecting the quality of life [24].…”

Early Diagnosis of Delirium in Palliative Care Patients Decreases Mortality and Necessity of Palliative Sedation: Results of a Prospective Observational Study

“…In the 27 patients who died naturally, death was the consequence of the organ dysfunctions, symptoms, and infectious complications that affect a terminally ill patient, plus the presence of delirium. This situation was expected and not particularly different from what commonly happens in the clinic experience [33]. In presenting the results, we considered natural death as a spontaneous event, not responsive to therapy and not indicated for palliative sedation.…”

Prevalence of Anti-neural Autoantibodies in a Psychiatric Patient Cohort-Paradigmatic Application of Criteria for Autoimmune-Based Psychiatric Syndromes

“…Our second patient with autoantibodies presented the paraneoplastic Zic4 antibody, supporting his potential for cancer-related immunity. Morbidity and mortality are high in patients with cancer and delirium ( 27 ), and delirium is particularly frequent in patients suffering from advanced malignancies ( 28 ). Risk factors in cancer patients for developing delirium include (besides the aforementioned paraneoplastic neuropsychiatric syndromes), primary CNS tumors or secondary CNS tumors entailing brain metastasis or meningeal metastasis, or encephalopathy following brain radiation for certain tumor types ( 29 ).…”