Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea.
Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.
Psychooncology. 2019 Jan;28(1):160-166. doi: 10.1002/pon.4926. Epub 2018 Nov 8.
Delirium is highly prevalent in patients with advanced cancer. This study aimed to investigate delirium rates and potential associated factors such as mortality in patients admitted to an acute palliative care unit (APCU). Our second aim was to validate the Korean version of the Memorial Delirium Assessment Scale (K-MDAS).
A total of 102 patients with advanced cancer, and who were admitted to the APCU, were assessed. Demographic data were collected alongside clinical diagnosis, Eastern Cooperative Oncology Group (ECOG) performance status, clinical symptoms according to the Edmonton Symptom Assessment System, history of smoking, alcohol use, hypnotic use, and daily dose of morphine were collected. The Confusion Assessment Method, the Delirium Rating Scale-Revised 98, and the K-MDAS were measured at admission and 1 week later.
Twenty-four patients (23.52%) were diagnosed with delirium, and associated factors were old age (P = 0.007), higher ECOG (P = 0.011), and drowsiness (P < 0.001). The presence of delirium was an independent predictor of 1-month mortality; male gender, higher body mass index, and hypnotic use were also related to 1-month mortality. The K-MDAS had reliable internal consistency (α = 0.942) and showed sensitivity of 0.958 and specificity of 0.921 at the optimal cutoff score for diagnosing delirium of 9.
Delirium was prevalent in patients admitted to the APCU and was associated with 1-month mortality. The K-MDAS showed acceptable reliability and validity and can be used to screen for delirium in a palliative care setting.
在晚期癌症患者中，谵妄的发生率很高。本研究旨在调查入住急性姑息治疗病房（APCU）的患者中谵妄的发生率以及可能的相关因素，如死亡率。我们的第二个目的是验证《纪念谵妄评估量表》（K-MDAS）的韩文版本。
共评估了 102 名患有晚期癌症并入住 APCU 的患者。收集了人口统计学数据，以及临床诊断、东部合作肿瘤学组（ECOG）表现状态、根据埃德蒙顿症状评估系统的临床症状、吸烟史、饮酒史、催眠药使用史和吗啡日剂量。在入院时和 1 周后使用意识混乱评估方法、修订后的谵妄评定量表-98 版和 K-MDAS 进行测量。
24 名患者（23.52%）被诊断为谵妄，相关因素为年龄较大（P=0.007）、ECOG 评分较高（P=0.011）和嗜睡（P<0.001）。谵妄的存在是 1 个月死亡率的独立预测因素；男性、较高的体重指数和催眠药使用也与 1 个月死亡率有关。K-MDAS 具有可靠的内部一致性（α=0.942），在诊断谵妄的最佳截断分数为 9 分时，其敏感性为 0.958，特异性为 0.921。
入住 APCU 的患者中谵妄很常见，与 1 个月死亡率相关。K-MDAS 显示出可接受的可靠性和有效性，可用于姑息治疗环境中筛查谵妄。
