Predictors of Delirium in Corticosteroid-Treated Patients with Advanced Cancer: An Exploratory, Multicenter, Prospective, Observational Study

Matsuo, Naoki; Morita, Tatsuya; Matsuda, Yoshinobu; Okamoto, Kenichiro; Matsumoto, Yoshihisa; Kaneishi, Keisuke; Odagiri, Takuya; Katayama, Hideki; Mori, Ichiro; Yamada, Haruo; Watanabe, Hiroaki; Yokoyama, Tetsuji; Yamaguchi, Takashi; Nishi, Tomohiro; Shirado, Akemi; Hiramoto, Shuji; Watanabe, Toshio; Kohara, Hiroyuki; Shimoyama, Satofumi; Aruga, Etsuko; Baba, Mika; Sumita, Koki; Iwase, Satoru

doi:10.1089/jpm.2016.0323

Cited by 12 publications

(65 citation statements)

References 33 publications

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“…35 Matsuo et al's naturalistic cohort study focused on CAH in patients with advanced cancer who had been prescribed steroids, revealing an association between lower received volume of CAH and the development of delirium (p=0.034). 36 Yamaguchi et al found worse agitation (p=0.025) and a higher prevalence of agitated delirium (p=0.009) in patients with advanced abdominal malignancies receiving less CAH. 37 Although participants in the latter two studies were mostly in the last weeks, rather than last days, of life, (and thus excluded from this review), together with the findings from the feasibility study included in this review, 20 there is a suggestion that CAH may reduce the incidence or severity of delirium as oral intake declines.…”

Section: Discussionmentioning

confidence: 94%

What is the impact of clinically assisted hydration in the last days of life? A systematic literature review and narrative synthesis

Kingdon

Spathis

Brodrick

et al. 2020

BMJ Support Palliat Care

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BackgroundClinically assisted hydration (CAH) can be provided in the last days of life as drinking declines. The impact of this practice on quality of life or survival in the last days of life is unclear. Practice varies worldwide concerning this emotive issue.MethodSystematic literature review and narrative synthesis of studies evaluating the impact of, or attitudes toward, CAH in the last days of life. Databases were searched up to December 2019. Studies were included if the majority of participants were in the last 7 days of life, and were evaluated using Gough’s 'Weight of Evidence' framework. Review protocol registered with PROSPERO, registration number CRD42019125837.ResultsFifteen studies were included in the synthesis. None were judged to be both of high quality and relevance. No evidence was found that the provision of CAH has an impact on symptoms or survival. Patient and family carer attitudes toward assisted hydration were diverse.ConclusionThere is currently insufficient evidence to draw firm conclusions on the impact of CAH in the last days of life. Future research needs to focus on patients specifically in the last days of life, include those with non-malignant diagnoses, and evaluate best ways to communicate effectively about this complex topic with patients and their families.

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Section: Discussionmentioning

confidence: 94%

What is the impact of clinically assisted hydration in the last days of life? A systematic literature review and narrative synthesis

Kingdon

Spathis

Brodrick

et al. 2020

BMJ Support Palliat Care

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Section: Study Characteristicsmentioning

confidence: 99%

“…The characteristics of the nine included studies were presented in Table 1 (9,10,(15)(16)(17)(18)(19)(20)(21). Among these studies, three were case-control studies (9,19,20), and five were cohort studies (10,(15)(16)(17)(18). The studies involved 4,939 subjects (899 delirium cases and 4,040 non-delirious controls) from five countries.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Two studies explored the risk factors for hyperactive delirium only (15,20), while another study investigated risk factors for hyperactive and mixed-type delirium (9). The remaining six studies did not mention the subtype of delirium (10,(17)(18)(19)21). Six studies reported the mean age of study participants from 64 to 72.9 years (9,10,15,(18)(19)(20).…”

Section: Study Characteristicsmentioning

confidence: 99%

“…The remaining six studies did not mention the subtype of delirium (10,(17)(18)(19)21). Six studies reported the mean age of study participants from 64 to 72.9 years (9,10,15,(18)(19)(20). All studies reported gender: 2,718 (55.03%) males, and 2,221 (44.97%) were female.…”

Section: Study Characteristicsmentioning

confidence: 99%

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Risk Factors for Delirium in the Palliative Care Population: A Systematic Review and Meta-Analysis

et al. 2021

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Objective: Delirium is common and highly distressing for the palliative care population. Until now, no study has systematically reviewed the risk factors of delirium in the palliative care population. Therefore, we performed a systematic review and meta-analysis to evaluate delirium risk factors among individuals receiving palliative care.Methods: We systematically searched PubMed, Medline, Embase, and Cochrane database to identify relevant observational studies from database inception to June 2021. The methodological quality of the eligible studies was assessed by the Newcastle Ottawa Scale. We estimated the pooled adjusted odds ratio (aOR) for individual risk factors using the inverse variance method.Results: Nine studies were included in the review (five prospective cohort studies, three retrospective case-control studies and one retrospective cross-section study). In pooled analyses, older age (aOR: 1.02, 95% CI: 1.01–1.04, I2 = 37%), male sex (aOR:1.80, 95% CI: 1.37–2.36, I2 = 7%), hypoxia (aOR: 0.87, 95% CI: 0.77–0.99, I2 = 0%), dehydration (aOR: 3.22, 95%CI: 1.75–5.94, I2 = 18%), cachexia (aOR:3.40, 95% CI: 1.69–6.85, I2 = 0%), opioid use (aOR: 2.49, 95%CI: 1.39–4.44, I2 = 0%), anticholinergic burden (aOR: 1.18, 95% CI: 1.07–1.30, I2 = 9%) and Eastern Cooperative Oncology Group Performance Status (aOR: 2.54, 95% CI: 1.56–4.14, I2 = 21%) were statistically significantly associated with delirium.Conclusion: The risk factors identified in our review can help to highlight the palliative care population at high risk of delirium. Appropriate strategies should be implemented to prevent delirium and improve the quality of palliative care services.

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Predisposing and Precipitating Factors Associated With Delirium

et al. 2023

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ImportanceDespite discrete etiologies leading to delirium, it is treated as a common end point in hospital and in clinical trials, and delirium research may be hampered by the attempt to treat all instances of delirium similarly, leaving delirium management as an unmet need. An individualized approach based on unique patterns of delirium pathophysiology, as reflected in predisposing factors and precipitants, may be necessary, but there exists no accepted method of grouping delirium into distinct etiologic subgroups.ObjectiveTo conduct a systematic review to identify potential predisposing and precipitating factors associated with delirium in adult patients agnostic to setting.Evidence ReviewA literature search was performed of PubMed, Embase, Web of Science, and PsycINFO from database inception to December 2021 using search Medical Subject Headings (MeSH) terms consciousness disorders, confusion, causality, and disease susceptibility, with constraints of cohort or case-control studies. Two reviewers selected studies that met the following criteria for inclusion: published in English, prospective cohort or case-control study, at least 50 participants, delirium assessment in person by a physician or trained research personnel using a reference standard, and results including a multivariable model to identify independent factors associated with delirium.FindingsA total of 315 studies were included with a mean (SD) Newcastle-Ottawa Scale score of 8.3 (0.8) out of 9. Across 101 144 patients (50 006 [50.0%] male and 49 766 [49.1%] female patients) represented (24 015 with delirium), studies reported 33 predisposing and 112 precipitating factors associated with delirium. There was a diversity of factors associated with delirium, with substantial physiological heterogeneity.Conclusions and RelevanceIn this systematic review, a comprehensive list of potential predisposing and precipitating factors associated with delirium was found across all clinical settings. These findings may be used to inform more precise study of delirium’s heterogeneous pathophysiology and treatment.

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Predictors of Delirium in Corticosteroid-Treated Patients with Advanced Cancer: An Exploratory, Multicenter, Prospective, Observational Study

Abstract: Delirium in corticosteroid-treated advanced cancer patients may be predicted by PS, drowsiness, and concurrent opioid use. Larger prospective studies are needed to confirm these results.

Cited by 12 publications

References 33 publications

What is the impact of clinically assisted hydration in the last days of life? A systematic literature review and narrative synthesis

What is the impact of clinically assisted hydration in the last days of life? A systematic literature review and narrative synthesis

Risk Factors for Delirium in the Palliative Care Population: A Systematic Review and Meta-Analysis

Predisposing and Precipitating Factors Associated With Delirium

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