Delirium associated with higher mortality risk among critically ill patients with cancer
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Key takeaways:
- ICU delirium is common among critically ill patients with cancer and is a significant risk factor for ICU and hospital mortality.
- Systematic screening for delirium and early mitigating interventions are warranted.
Delirium appeared associated with higher ICU and hospital mortality, as well as increased length of stay, among critically ill patients with cancer, according to data published in JCO Oncology Practice.
Those who developed delirium had an almost six times higher likelihood of death in the hospital and more than 10 times higher likelihood of death in an ICU that those who did not, researchers wrote.
“Our study, which examined a large cohort of [well-mixed] medical-surgical patients, found delirium to be a significant risk factor for both ICU and hospital mortality in univariable and multivariable analyses,” Jing Tao, MD, assistant attending anesthesiologist at Memorial Sloan Kettering Cancer Center, and colleagues wrote.
Background and methodology
Delirium is common in patients with a critical illness and can occur due to sepsis, shock and/or polypharmacy, according to study background.
Tao and colleagues retrospectively analyzed 915 critically ill patients with active cancer (56.2% men; median age, 64.9 years [interquartile range, 54.6-73.2]; 70.8% white) with an ICU stay of at least 24 hours at Memorial Sloan Kettering Cancer Center between January and December 2018. The most common malignancies included hematologic (25.7%) and gastrointestinal (20.9%) cancers.
Researchers performed delirium screening twice a day using the Confusion Assessment Method, which incorporates acute fluctuations in mental status, inattention, disorganized thinking and altered levels of consciousness.
Results
Results showed delirium in 40.5% (n = 317) of evaluable patients.
Researchers found delirium to be an independent risk factor for higher ICU mortality (OR = 10.75; 95% CI, 5.91-19.55), hospital mortality (OR = 5.84; 95% CI, 4.03-8.46) and ICU length of stay (estimate = 1.67; 95% CI, 1.54-1.81).
Delirium appeared independently associated with age (OR = 1.01; 95% CI, 1-1.02), longer pre-ICU hospital length of stay (OR = 1.04; 95% CI, 1.02-1.06), do not resuscitate on admission (OR = 2.18; 95% CI, 1.07-4.44), central nervous system involvement (OR = 2.25; 95% CI, 1.2-4.2), higher Mortality Probability Model II score (OR = 1.02; 95% CI, 1.01-1.02), mechanical ventilation (OR = 2.67; 95% CI, 1.84-3.87) and sepsis diagnosis (OR = 0.65; 95% CI, 0.43-0.99).
Study limitations included its retrospective and single-center design, which predisposes it to confounders and selection bias, researchers wrote.
Next steps
Clinicians who care for critically ill patients with cancer should be aware of the frequency of delirium among this patient population and its association with high ICU and hospital mortality and length of stay, according to researchers.
“Critical care specialists should perform systematic screening for delirium in patients with cancer admitted to the ICU and implement early mitigating interventions to prevent delirium and shorten its duration,” they wrote.
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