High proportion of thiamine deficiency in referred cancer patients with delirium: a retrospective descriptive study

Abstract

Background/Objectives Recent studies have revealed thiamine deficiency (TD) as a cause of delirium in cancer patients. However, the extent to which Wernicke encephalopathy is present and in what patients is not well understood. Subjects/Methods In this retrospective descriptive study, we investigated referred cancer patients who were diagnosed with delirium by a psycho-oncologist to clarify the proportion of TD, the therapeutic effect of thiamine administration, and the factors involved in its onset. Results Among 71 patients diagnosed with delirium by a psycho-oncologist, TD was found in 45% of the patients. Intravenous administration of thiamine led to a recovery in about 60% of these patients. We explored the factors associated with TD using a multivariable regression model with a Markov chain Monte Carlo imputation procedure. We found an association between TD and chemotherapy (adjusted odds ratio, 1.98 [95% confidence interval, 1.04–3.77]); however, there were no significant associations between TD and the other factors we considered. Conclusions TD is not particularly rare in delirium patients undergoing psychiatric consultation. The delirium was resolved in more than half of these patients by intravenous administration of thiamine. Oncologists should consider TD as a cause of delirium in cancer patients. Further prospective study is needed to clarify the relationship between TD and delirium in cancer patients.

Delirium in Critical Illness Patients and the Potential Role of Thiamine Therapy in Prevention and Treatment: Findings from a Scoping Review with Implications for Evidence-Based Practice

“…Finally, a statistically significant association was found only between chemotherapy and thiamine deficiency. Other variables such as age, gender, albumin level, BMI, lactate dehydrogenase (LDH) level, gastrointestinal malignancy, performance status, hormonal therapy, radiotherapy, surgery, diabetes, hypertension, and cardiac disorders were not statistically significant [30].…”

“…Thiamine deficiency also occurs in conditions where the supply of thiamine from food is reduced, or its absorption is impaired. These include oral and gastrointestinal cancers and surgical procedures in the gastrointestinal tract [29,30].…”

Wernicke encephalopathy in a lung cancer patient receiving home medical care

“…In this case, blood was collected to examine VB1 the very first time a reduction in appetite was reported. As store of VB1 in the body is depleted in about 18 days (MacLean et al, 1983), it is not uncommon for cancer patients to exhibit VB1 deficiency (Yoshioka et al, 2021;Onishi et al, 2021), and it is considered appropriate to actively suspect TD if there is a loss of appetite.…”

“…At present, the most useful diagnostic tool for WE is clinical suspicion (Sechi and Serra, 2007). Recent clinical studies have revealed that WE is quite common in cancer patients (Isenberg-Grzeda et al, 2017), being observed during chemotherapy, psychiatric examination, in patients with delirium, on admission to palliative care units, at the end of life and so on (Barbato and Rodriguez, 1994;Onishi et al, 2016Onishi et al, , 2018aOnishi et al, , 2021. Cancer patients often want to spend their final days at home (Nakamura et al, 2010;Rainsford et al, 2016).…”

Communication at the End of Life

“…Notably, there are many cases in which patients referred for an examination for depression also suffer from delirium [19].…”