Opioid medications and longitudinal risk of delirium in hospitalized cancer patients

Abstract

BACKGROUND.Delirium is an important problem in hospitalized cancer patients. The objective of this study was to determine whether exposure to corticosteroids, benzodiazepines, or opioids predicted delirium.METHODS.A prospective cohort study was conducted in an oncology/internal medicine population. Patients were assessed continuously for the presence of delirium until they were discharged by using the Nursing Delirium Screening Scale (Nu‐DESC). Follow‐up for outcome began after incident delirium. The primary outcome was the presence of a delirium event, which was defined as a Nu‐DESC score >1. Strengths of associations of medications with delirium were expressed as odds ratios (ORs) in univariate and multivariate analyses.RESULTS.In total, 114 patients (1823 patient‐days) met the inclusion criteria for the study. The mean follow‐up from incident delirium was 16 days. The mean number of delirium events by patient was 6 (total number, 667 delirium events). Analysis by day on several occasions revealed significant associations between opioids and delirium. Corticosteroids and benzodiazepines were not associated significantly with an increased risk of delirium on any given day. Analysis by patient using generalized estimating equation (GEE) models showed an increased risk of delirium on any day of follow‐up associated with opioid exposure in univariate analysis (OR of 1.70; P < .0001). The association remained significant after adjustment for corticosteroid, benzodiazepine, and antipsychotic exposure using GEE regressions (OR of 1.37; P = .0033). Truncating follow‐up at 30 days did not affect the results (OR of 1.38; P < .032).CONCLUSIONS.Exposure to opioids during hospitalization was associated significantly with an increased longitudinal risk of delirium. Cancer 2007. © 2007 American Cancer Society.

Clarifying Delirium Management: Practical, Evidenced-Based, Expert Recommendations for Clinical Practice

“…29,40,59,61 Some that are particularly frequent in this population, such as constipation and urinary retention, are easily addressed. The most common causes of delirium found in patients with serious and/or advanced illness are fluid and electrolyte imbalances; medications (benzodiazepines, 52,53 opioids, 29,[53][54][55] steroids, 53,54,56 and anticholinergics 57,58 ); infections; hepatic or renal failure; hypoxia; and hematological disturbances. 29,59 Once the diagnosis of delirium is made, the assessment of any associated symptoms, likely underlying cause(s), the patient's functional status and prognosis, and patient and family goals of care will help to determine whether the delirium is potentially reversible or irreversible.…”

Pre- and Post-Transplantation Risk Factors for Delirium Onset and Severity in Patients Undergoing Hematopoietic Stem-Cell Transplantation

“…6,16,19 Chemotherapeutic or immunotherapeutic agents (eg, vincristine, interleukin-2, interferon, corticosteroids) may cause toxic CNS effects. 5,[18][19][20][21] Infection or hepatic, renal, metabolic, or respiratory complications may cause delirium. 5,10,18,19 Finally, agents used in supportive care may precipitate delirium, including analgesics (especially opioids), antiemetics, sedatives, and antimicrobials.…”

“…5,10,18,19 Finally, agents used in supportive care may precipitate delirium, including analgesics (especially opioids), antiemetics, sedatives, and antimicrobials. 5,10,18,19,21,22 Previously, we determined pretransplantation factors associated with delirium occurrence and severity in this population. 1 No studies have examined both pretransplantation and longitudinal or timevariant post-transplantation factors associated with delirium onset and severity in patients who have received myeloablative HSCT.…”

Delirium in Critically ill Patients in a Tertiary Care Centre in Western Region of Nepal

“…6,12,24,25 Current study did not find a statistically significant increase in risk of occurrence of delirium with use of benzodiazepine (OR= 3.042 95% CI=0.669;13.830) or use of opiates (OR= 0.781 95% CI= 0.1572;3.880) during current admission. This finding should be interpreted with limitation of current study in mind; which is its relatively small size.…”