Lee S W, Jung E H, Kim H J, Min C, Yoo S H, Kim Y J, Rha S Y, Yon D K, Kang B
Palliative Care Center, Division of Medical Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, South Korea.
Eur Rev Med Pharmacol Sci. 2023 Mar;27(5):2068-2076. doi: 10.26355/eurrev_202303_31578.
Previous studies have comprehensively investigated the prevalence and various potential risk factors for delirium among patients with advanced cancer admitted to the acute palliative care unit (APCU). Our objective was to evaluate the comprehensive association between delirium and various risk factors among patients with advanced cancer in an acute palliative care setting using a patient-based multicenter registry cohort.
We performed a multicenter, patient-based registry cohort study collected in South Korea between January 1, 2019, and December 31, 2020. Delirium was identified using a medical record review based on the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.
In total, 2,124 eligible patients with advanced cancer in the APCU met the inclusion criteria. There were 127 out of 2,124 patients (prevalence, 6.0%; 95% CI, 5.0 to 7.1) with delirium during admission. Delirium in patients with advanced cancer was associated with age >70 years (OR, 1.793; 95% CI, 1.246 to 2.581), male sex (OR, 1.675; 95% CI, 1.131 to 2.479), no chemotherapy during hospitalization (OR, 2.019; 95% CI, 1.236 to 3.298), hearing impairment (OR, 3.566; 95% CI, 1.176 to 10.810), underweight (OR, 1.826; 95% CI, 1.067 to 3.124), current use of opioid medication (OR, 1.942; 95% CI, 1.264 to 2.982), previous history of delirium (OR, 12.497; 95% CI, 6.920 to 22.568), and mental illness (OR, 2.333; 95% CI, 1.251 to 4.352).
In a large-scale multicenter patient-based registry cohort, delirium was associated with old age, male sex, no chemotherapy during hospitalization, hearing impairment, underweight, current use of opioid medication, and a history of delirium and mental illness. Our findings suggest physicians should pay attention to delirium in patients with advanced cancer admitted to the APCU with the above risk factors.
既往研究已全面调查了入住急性姑息治疗病房（APCU）的晚期癌症患者中谵妄的患病率及各种潜在危险因素。我们的目的是利用基于患者的多中心登记队列，评估急性姑息治疗环境下晚期癌症患者中谵妄与各种危险因素之间的综合关联。
我们进行了一项多中心、基于患者的登记队列研究，研究对象为2019年1月1日至2020年12月31日期间在韩国收集的患者。根据《精神疾病诊断与统计手册》第五版的标准，通过病历审查来确定谵妄。
APCU中共有2124例符合条件的晚期癌症患者符合纳入标准。2124例患者中有127例（患病率为6.0%；95%置信区间为5.0%至7.1%）在入院期间发生谵妄。晚期癌症患者的谵妄与年龄>70岁（比值比[OR]为1.793；95%置信区间为1.246至2.581）、男性（OR为1.675；95%置信区间为1.131至2.479）、住院期间未进行化疗（OR为2.019；95%置信区间为1.236至3.298）、听力障碍（OR为3.566；95%置信区间为1.176至10.810）、体重过轻（OR为1.826；95%置信区间为1.067至3.124）、当前使用阿片类药物（OR为1.942；9%置信区间为1.264至2.982）、既往有谵妄病史（OR为12.497；95%置信区间为6.920至22.568）以及精神疾病（OR为2.333；95%置信区间为1.251至4.35）有关。
在一个大规模的多中心基于患者的登记队列中，谵妄与老年、男性、住院期间未进行化疗、听力障碍、体重过轻、当前使用阿片类药物以及有谵妄和精神疾病病史有关。我们的研究结果表明，医生应关注具有上述危险因素且入住APCU的晚期癌症患者的谵妄情况。
