Transplantation Risk Factors of Delirium Onset Identified

Higher-dose opioid medication use linked to more severe delirium post-stem-cell transplantation

THURSDAY, Jan. 27 (HealthDay News) -- Pre- and post-transplantation risk factors may be able to assist in identifying patients at risk for delirium onset and severity during the acute phase of myeloablative hematopoietic stem-cell transplantation (HSCT), according to a study published online Jan. 24 in the Journal of Clinical Oncology.

Jesse R. Fann, M.D., M.P.H., from the University of Washington in Seattle, and colleagues assessed 90 adults with malignancies who were admitted to the Fred Hutchinson Cancer Research Center for their first HSCT, from a week before the transplantation to 30 days after. Delirium was assessed three times a week, and potential risk factors were assessed by patient self-reports, charts, and computerized records. Time to onset of delirium and delirium severity were analyzed.

The investigators found that 50 percent of patients experienced a delirium episode. Pre-transplantation risk factors for onset and severity included increased average alkaline phosphatase and blood urea nitrogen levels. Reduced executive functioning before transplantation was also associated with higher delirium severity. Higher doses of opioid medications were the only post-transplantation risk factor for onset of delirium. Increased delirium severity was associated with higher opioid doses, current and prior pain, and higher blood urea nitrogen levels.

"Pre- and post-transplantation risk factors will help clinicians identify patients at risk for delirium during their transplantation course and, combined with detection of prodromal delirium symptoms, such as attentional, perceptual, and cognitive disturbances, may enable clinical interventions to prevent delirium onset or decrease delirium symptoms," the authors write.

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