Use of medications that antagonize mediators of inflammatory responses may reduce the risk of delirium in older adults: a nested case–control study

Cole, Martín G.; McCusker, Jane; Wilchesky, Machelle; Voyer, Philippe; Monette, Johanne; Champoux, Nathalie; Vu, Minh; Ciampi, Antonio; Belzile, Éric

doi:10.1002/gps.4468

Cited by 2 publications

(10 citation statements)

References 43 publications

(40 reference statements)

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“…In PCs (Table 2), RoB was balanced overall. Nested CCs 55,56 did not exhibit limitations or RoB (Table 2). In general, our assessment corresponded to the RoB appraisal by Clegg and Young but two PCs 43,45 were estimated as of “low quality” by Clegg and Young, while our assessment resulted in a NOS‐score = 7 (comparable to unclear RoB).…”

Section: Resultsmentioning

confidence: 95%

“…Heterogeneity was low when results for diphenhydramine were pooled (I 2 = 0%, p = 0.38) 55,56 . The effect estimate indicates an insignificant positive association (aOR 1.50, 95% CI: 0.64–3.54; AR: 35 more per 1000, 95% CI: 27 fewer to 153 more).…”

Section: Resultsmentioning

confidence: 99%

“…Evidence quality needed to be downgraded to very low due to serious inconsistency (I 2 = 83%) and imprecision. Heterogeneity might be explained by the fact that H 1 ‐antihistamines as a medication class 55 were compared to diphenhydramine as a specific agent 56 . The clinical settings were also heterogeneous (long term care facilities 55 vs. mixed surgical) 56 …”

Section: Resultsmentioning

confidence: 99%

“…In full text screening, the eligibility criteria (see Appendix S3 ) was applied to 85 studies, after which 54 works needed to be excluded. The 31 studies met eligibility criteria (11 randomized controlled trials [RCTs], 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 17 PC studies [PCs] 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 and 3 prospective case–control studies [CCs] 54 , 55 , 56 of which seven works 28 , 41 , 42 , 43 , 44 , 45 , 56 were included from the previous review). 9 The detailed selection process, describing the in‐ and exclusion (with reasons) of retrieved studies, is outlined in Figure 1 .…”

Section: Resultsmentioning

confidence: 99%

“…Heterogeneity might be explained by the fact that H 1 -antihistamines as a medication class 55 were compared to diphenhydramine as a specific agent. 56 The clinical settings were also heterogeneous (long term care facilities 55 vs. mixed surgical). 56 Heterogeneity was low when results for diphenhydramine were pooled (I 2 = 0%, p = 0.38).…”

Section: Benzodiazepinesmentioning

confidence: 99%

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Delirium‐associated medication in people at risk: A systematic update review, meta‐analyses, and GRADE‐profiles

Reisinger

Reininghaus

Biasi

et al. 2022

Acta Psychiatr Scand

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Background: Drug-associated delirium is a common but potentially preventable neuropsychiatric syndrome associated with detrimental outcomes. Empirical evidence for delirium-associated medication is uncertain due to a lack of highquality studies. We aimed to further investigate the body of evidence for drugs suspected to trigger delirium.Methods: A systematic update review and meta-analyses of prospective studies presenting drug associations with incident delirium in adult study populations was conducted. Two authors independently searched MEDLINE, PsycINFO, Embase, and Google Scholar dated from October 1, 2009 to June 23, 2020, after screening a previous review published in 2011. The most reliable results on drug-delirium associations were pooled in meta-analyses using the random-effects model. Quality of evidence was assessed using the GRADEapproach. This study is preregistered with OSF (DOI https://doi.org.10.17605/ OSF.IO/4PUHY). Results:The 31 eligible studies, presenting results for 24 medication classes were identified. Meta-analyses and GRADE level of evidence ratings show no increased delirium risk for Haloperidol (OR: 0.96, 95% CI 0.72-1.28; high-quality evidence), Olanzapine (OR: 0.25, 95% CI 0.15-0.40), Ketamine (OR: 0.72, 95% CI 0.35-1.46) or corticosteroids (OR: 0.69, 95% CI 0.32-1.50; moderate quality evidence, respectively). Low-level evidence suggests a three-fold increased risk for anticholinergics (OR: 3.11, 95% CI 1.04-9.26). Opioids, benzodiazepines, H 1 -antihistamines, and antidepressants did not reach reliable evidence levels in our analyses. Conclusion:We investigated the retrievable body of evidence for deliriumassociated medication. The results of this systematic review were then interpreted in conjunction with other evidence-based works and guidelines providing conclusions for clinical decision-making.

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Section: Resultsmentioning

confidence: 95%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Benzodiazepinesmentioning

confidence: 99%

See 3 more Smart Citations

Delirium‐associated medication in people at risk: A systematic update review, meta‐analyses, and GRADE‐profiles

Reisinger

Reininghaus

Biasi

et al. 2022

Acta Psychiatr Scand

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Dexmedetomidine in the prevention of postoperative delirium in elderly patients following non‐cardiac surgery: A systematic review and meta‐analysis

Shen

Li²,

Zhou

et al. 2020

Clin Exp Pharma Physio

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The efficacy of dexmedetomidine in the prevention of postoperative delirium (POD) remains ambiguous, however, it has been used to reduce the incidence of delirium in elderly patients. Here, we conducted a meta‐analysis study for assessing the effects of dexmedetomidine on POD among elderly patients following non‐cardiac surgery. A systematic literature search was performed against the PubMed, EMBASE, Cochrane Library, and Web of Science databases, and all relevant literature published till November 30, 2019, were considered. Our analysis included 16 randomised controlled trials conducted with 4534 patients for exploring the effects of dexmedetomidine on POD in elderly patients following non‐cardiac surgery. It was observed that the overall incidence of POD was significantly lower in the dexmedetomidine group than in the control group (risk ratio [RR] 0.51, 95% confidence interval [CI] 0.43–0.61, P < .01). Similar results were obtained from subgroup analysis upon comparison of the placebo (RR 0.52, 95% CI 0.41–0.66, P < .01, moderate quality of evidence), propofol‐treated (RR 0.55, 95% CI 0.38–0.78, P < .01, low quality of evidence), and midazolam‐treated (RR 0.38, 95% CI 0.20–0.71, P < .01, low quality of evidence) groups. Trial sequential analysis revealed that the cumulative z‐value superseded the monitoring boundary and reached the required information size. However, patients who received dexmedetomidine had a higher incidence of bradycardia and hypotension. In conclusion, the meta‐analysis revealed that dexmedetomidine appears to decrease the risk of POD in elderly patients following non‐cardiac surgery. However, as some of the studies were heterogeneous and of low quality, high‐quality trials are necessary for drawing more definitive conclusions.

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Use of medications that antagonize mediators of inflammatory responses may reduce the risk of delirium in older adults: a nested case–control study

Cited by 2 publications

References 43 publications

Delirium‐associated medication in people at risk: A systematic update review, meta‐analyses, and GRADE‐profiles

Delirium‐associated medication in people at risk: A systematic update review, meta‐analyses, and GRADE‐profiles

Dexmedetomidine in the prevention of postoperative delirium in elderly patients following non‐cardiac surgery: A systematic review and meta‐analysis

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