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Risk factors for delirium in patients undergoing hematopoietic stem cell transplantation

Michelle T. Weckmann, MS, MD

Department of Family Medicine, Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, IA, USA

Roger Gingrich, MD

Department of Internal Medicine, Division of Hematology, Oncology and Blood and Marrow Transplantation, University of Iowa Carver College of Medicine, Iowa City, IA, USA

James A. Mills, MS

Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, IA, USA

Larry Hook, MD

Department of Psychiatry, Medical College of Wisconsin, Milwaukee, WI, USA

Leigh J. Beglinger, PhD

Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, IA, USA

BACKGROUND: Delirium is common after hematopoietic stem cell transplantation (HSCT) and is associated with increased morbidity and mortality. Early recognition and treatment have been shown to improve long-term outcomes. We sought to investigate the relationship between potential risk factors and the development of delirium following HSCT.

METHODS: Fifty-four inpatients admitted for HSCT were assessed prospectively for delirium every 2 to 3 days during their inpatient stay using standardized delirium and neuropsychological measures. Self reports of medical history, medical records, and neurocognitive and psychiatric assessments were used to identify risk factors. Both pre- and post-HSCT risk factors were examined.

RESULTS: Delirium incidence was 35% and occurred with highest frequency in the 2 weeks following transplant. The only pre-transplantation risk factor was lower oxygen saturation (P = .003). Post-transplantation risk factors for delirium included higher creatinine (P < .0001), higher blood urea nitrogen levels (P = .005), lower creatinine clearance (P = .0006), lower oxygen saturation (P = .001), lower hemoglobin (P = .04), and lower albumin (P = .03). There was no observed association with level of cognitive performance, transplant type, disease severity, medical comorbidity index, age, or conditioning regimen.

CONCLUSIONS: Routine laboratory values can assist in the identification of high-risk patients before delirium onset to improve early detection and treatment of delirium after HSCT.

KEYWORDS: delirium, risk factors, cancer, hematopoietic stem cell transplantation

CORRESPONDENCE: Michelle T. Weckmann, MS, MD, Department of Family Medicine, 01102 PFP, University of Iowa Carver College of Medicine, Iowa City, IA 52242-1000 USA E-MAIL: michelle-weckmann@uiowa.edu
Annals of Clinical Psychiatry ©2012 Quadrant HealthCom Inc.

 
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