Outcome, demography and resource utilization in ICU Patients with delirium and malignancy

Abstract

Delirium in the general intensive care unit (ICU) population is common, associated with adverse outcomes and well studied. However, knowledge on delirium in the increasing number of ICU patients with malignancy is scarce. The aim was to assess the frequency of delirium and its impact on resource utilizations and outcomes in ICU patients with malignancy. This retrospective, single-center longitudinal cohort study included all patients with malignancy admitted to ICUs of a University Hospital during one year. Delirium was diagnosed by an Intensive Care Delirium Screening Checklist (ICDSC) score ≥ 4. Of 488 ICU patients with malignancy, 176/488 (36%) developed delirium. Delirious patients were older (66 [55–72] vs. 61 [51–69] years, p = 0.001), had higher SAPS II (41 [27–68] vs. 24 [17–32], p < 0.001) and more frequently sepsis (26/176 [15%] vs. 6/312 [1.9%], p < 0.001) and/or shock (30/176 [6.1%] vs. 6/312 [1.9%], p < 0.001). In multivariate analysis, delirium was independently associated with lower discharge home (OR [95% CI] 0.37 [0.24–0.57], p < 0.001), longer ICU (HR [95% CI] 0.30 [0.23–0.37], p < 0.001) and hospital length of stay (HR [95% CI] 0.62 [0.50–0.77], p < 0.001), longer mechanical ventilation (HR [95% CI] 0.40 [0.28–0.57], p < 0.001), higher ICU nursing workload (B [95% CI] 1.92 [1.67–2.21], p < 0.001) and ICU (B [95% CI] 2.08 [1.81–2.38], p < 0.001) and total costs (B [95% CI] 1.44 [1.30–1.60], p < 0.001). However, delirium was not independently associated with in-hospital mortality (OR [95% CI] 2.26 [0.93–5.54], p = 0.074). In conclusion, delirium was a frequent complication in ICU patients with malignancy independently associated with high resource utilizations, however, it was not independently associated with in-hospital mortality.

Delirium as a Risk Factor for Mortality in Critically Ill Patients With Cancer

“…This frequency is similar to previous reports on critically ill, but not terminally ill, patients with cancer requiring ICU care, which ranges from 22.9% to 39.3%. 22-24 It is also comparable with rates of delirium in ICU patients without cancer, which range from 20% to 80%. 9,28 In addition, we also found that patients with delirium had significantly higher ICU and hospital mortality compared with patients without delirium.…”

“…8,10,29,30 However, this association is yet to be fully appreciated in patients with cancer admitted to the ICU. Sieber et al 24 found delirium in this patient subgroup to increase hospital mortality by almost 6-fold in univariable analysis, but results failed to maintain significance after controlling for severity of illness, sepsis, and shock. On the other hand, Sanchez-Hurtado et al 22 noted a lower ICU mortality in patients with cancer diagnosed with delirium (12%) than in those with no delirium (15%).…”

“…20 To date, there have been only four studies conducted on delirium in ICU patients with cancer who are not at the end of life. [21][22][23][24] These analyses also suffer from small sample size, have widely varying results, and lack indepth outcomes analysis.…”

effect of controlled sedation based on Richmond scale on the duration of mechanical ventilation in patients admitted to ICU

“…The total score of patient's readiness for separation is 26. When the patient obtains a score of above 17, he/she is ready to be separated from mechanical ventilation 27,28 . Burn et al (1990) believed that, this checklist is able to predict the successful separation of patient from mechanical ventilation by 85% for 72 hours 24,26 .…”

Assessment of the Delirium Prevalence Among Pediatric Patients Admitted to the Pediatric Intensive Care Unit in West of Iran

“…On the other hand, the patients may be exposed to hypoactive delirium and be neglected by the treatment staff due to their calm appearance and, therefore, be susceptible to pressure ulcers or pneumonia more frequently. This group of patients, moreover, has symptoms of lethargy, impatience, and depression (9)(10)(11).…”