Predictive Factors for Agitation Severity of Hyperactive Delirium in Terminally Ill Cancer Patients in a General Hospital Using Ordered Logistic Regression Analysis

Abstract

Our study indicates that male sex, T-bil, antibiotic therapy, NSAID therapy, and hematological malignancy are significant predictors for agitation severity of hyperactive delirium in terminally ill cancer patients in a general hospital setting.

Comparison of the prevalence and associated factors of hyperactive delirium in advanced cancer patients between inpatient palliative care and palliative home care

“…3,11,16 However, several studies demonstrated that item 9 is associated with the neurobehavioral dimension and severity of agitation, and they used it as an outcome variable to assess hyperactive delirium in terminally ill cancer patients. [13][14][15] Although this limitation was unlikely to have a significant impact on the results of our study, the validity and reliability need to be assessed between the total MDAS score and item 9 of the MDAS.…”

“…14 The rationale for adopting item 9 of the MDAS as an outcome measurement instead of the total MDAS score was that several studies demonstrated that item 9 can distinguish the severity of agitation, and thus be used as an outcome variable to assess hyperactive delirium in terminally ill cancer patients. [13][14][15] The physicians coded item 9 with "hyperactive features" or "mixed features" based on the last few hours of observations. We assessed the presence of agitated delirium on admission and at 3 days before death.…”

“…We used item 9 of the Memorial Delirium Assessment Scale (MDAS#9) to assess the subtypes and severity of delirium at the time of assessment. 1,[13][14][15] Agitated delirium was defined as being present when delirium was diagnosed using the DSM5, and classified into either hyperactive or mixed type using item 9 of the MDAS at the time of assessment, which was a score of 2 (moderate) or 3 (severe). In addition, Nagase et al defined patients who had a score on MDAS#9 of 2 (moderate) or higher as agitated patients.…”

“…We assessed the presence of agitated delirium on admission and at 3 days before death. To adjust for background factors with a potential influence on the prevalence of agitated delirium at the time of assessment, we collected several other data on the day of enrollment based on previous studies and discussion among researchers, 11,13,[16][17][18][19] including age, gender, Eastern Co-operative Oncology Group Performance Status (ECOG PS), central nervous system metastasis, chemotherapy within a month, use of oxygen therapy, use of any catheter, age-adjusted Charlson Comorbidity Index (ACCI), 20,21 pleural effusion, asities, symptom severity defined by the Integrated Palliative Care Outcome Scale (IPOS), [22][23][24] opioid dosage, usage of antipsychotics, usage of benzodiazepines, data to formulate Prognosis in Palliative Care Study predictor models-A (PiPS-A), 25,26 site of primary cancer, metastatic site, Abbreviated Mental Test judged by the physician, heart rate, anorexia, dysphagia, dyspnea, and weight loss in the previous month. We assessed the symptom severity of pain, shortness of breath, weakness or lack of energy, drowsiness, and sore or dry mouth using IPOS, which was scored as 0 (not at all), 1 (slight), 2 (moderate), 3 (severe), and 4 (overwhelming), and defined the prevalence as any IPOS symptoms specified as 2 (moderate), 3 (severe), or 4 (overwhelming).…”

“…As possible factors affecting the prevalence of agitated delirium on admission, we used the following independent variables based on previous studies and discussion among the authors 11,13,[16][17][18][19] : place of care, age (≥65 years), gender, presence of central nervous system metastasis, chemotherapy within a month, ECOG PS (≥3 on admission), modified PiPS-A (months, weeks, days), ACCI, using oxygen therapy, using any catheter, and opioid dosage on admission (oral morphine equivalent: OME ≥60 mg/day). Similarly, as possible factors affecting the prevalence of agitated delirium 3 days before death, we used the following independent variables based on previous studies and discussion among the authors 11,13,[16][17][18][19] : place of care, age (≥65 years), gender, presence of central nervous system metastasis, chemotherapy within a month, ECOG PS (≥3 on admission), modified PiPS-A (months, weeks, days), ACCI, opioid dosage 1 week before death (oral morphine equivalent ≥60 mg/day), 18 symptoms 3 days before death, fever, and parenteral hydration 1 week before death. We defined the presence of symptoms as any IPOS symptoms specified as moderate, severe, or debilitating based on a previous study.…”