1Department of Pharmacy Practice, Massachusetts College of Pharmacy & Health Sciences University, Boston, MA, USA.
Palliat Med. 2014 Apr;28(4):335-41. doi: 10.1177/0269216314522105. Epub 2014 Feb 17.
Delirium may complicate the hospital course and adversely impact remaining quality of life for palliative care inpatients. Medications with anticholinergic properties have been linked to delirium within elderly populations via serum anticholinergic assays.
The aim of this study is to determine whether increasing anticholinergic burden, as measured using a clinical assessment tool, is associated with an increase in delirium among palliative care inpatients.
This study was completed as a retrospective, case-control study.
SETTING/PARTICIPANTS: Veterans admitted to the Veterans Affairs Boston Healthcare System and consulted to the palliative care service were considered for inclusion. Increase in anticholinergic burden from admission through hospital day 14 was assessed using the Anticholinergic Risk Scale. Presence of delirium was determined by use of a validated chart review instrument.
A total of 217 patients were analyzed, with a mean age of 72.9 (±12.8) years. The overall delirium rate was 31% (n = 67). Patients with an increase in Anticholinergic Risk Scale (n = 72 (33%)) were 40% more likely to experience delirium (odds ratio = 1.44, 95% confidence interval = 1.07-1.94) compared to those without increase (n = 145 (67%)). After adjustment for age, brain metastasis, intensive care unit admission, illness severity, opiate use, and admission Anticholinergic Risk Scale using multivariable modeling, delirium risk remained significantly higher in patients with an Anticholinergic Risk Scale increase compared to those without increase (adjusted odds ratio = 1.43, 95% confidence interval = 1.04-1.94).
An increase in Anticholinergic Risk Scale from admission was associated with delirium in palliative care inpatients. While additional study is needed, anticholinergic burden should be increased cautiously in palliative inpatients, and those with increases should be closely followed for delirium.
谵妄可能使姑息治疗住院患者的住院过程复杂化，并对其剩余的生活质量产生不利影响。通过血清抗胆碱能测定，具有抗胆碱能特性的药物与老年人群中的谵妄有关。
本研究旨在确定使用临床评估工具测量的抗胆碱能负担增加是否与姑息治疗住院患者的谵妄发生率增加有关。
本研究为回顾性病例对照研究。
地点/参与者：退伍军人事务部波士顿医疗保健系统入院并咨询姑息治疗服务的退伍军人被认为符合纳入标准。通过使用抗胆碱能风险量表评估从入院到住院第 14 天的抗胆碱能负担增加。使用经过验证的图表审查工具确定谵妄的存在。
共分析了 217 例患者，平均年龄为 72.9（±12.8）岁。总体谵妄发生率为 31%（n=67）。抗胆碱能风险量表增加的患者（n=72（33%））发生谵妄的可能性增加 40%（优势比=1.44，95%置信区间=1.07-1.94），而未增加的患者（n=145（67%））。在校正年龄、脑转移、入住重症监护病房、疾病严重程度、阿片类药物使用和入院时抗胆碱能风险量表后，多变量模型显示，与未增加的患者相比，抗胆碱能风险量表增加的患者发生谵妄的风险仍然显著更高（调整后的优势比=1.43，95%置信区间=1.04-1.94）。
从入院开始，抗胆碱能风险量表的增加与姑息治疗住院患者的谵妄有关。虽然需要进一步研究，但在姑息治疗住院患者中应谨慎增加抗胆碱能负担，并且应密切监测增加的患者出现谵妄的情况。
