Introduction

Delirium is a common neuropsychiatric syndrome in hospitalized cancer patients that is associated with poor outcomes such as increased mortality and prolonged hospital stays. However, clinical predictors of delirium-related outcomes in acutely hospitalized, non-surgical cancer patients remain underexplored.

Methods

This was a retrospective cohort study of hospitalized cancer patients at a tertiary-care oncology center between May 2024 and August 2024 who developed delirium. Delirium was defined by a positive Confusion Assessment Method (CAM) screen. Patients who were admitted for surgical reasons or had an altered mental status (AMS) present on admission were excluded. Patient demographics and clinical factors associated with their hospital course were abstracted from electronic medical records. Primary outcomes analyzed were in-hospital mortality, delirium duration, and length of stay (LOS).

Results

A total of 126 patients met the inclusion criteria from a screening pool of 219 patients. The median age was 65.5 years (IQR: 58,73) and 65 patients (51.6%) were male. Nearly half (43.7%) had hematologic malignancies. Twenty patients (15.9%) died during hospitalization. Non-survivors had significantly lower albumin (3.0 vs 3.5 g/dL, P < 0.01), platelets (86 vs 190 × 10³/µL, P = 0.031), BMI (23.3 vs 27.1 kg/m², P = 0.046), and higher LDH (515 vs 273 U/L, P = 0.044). They also experienced delirium for longer (median 3 vs 1 days, P = 0.011), had a higher incidence of sepsis (27% vs 14%, P = 0.015), and received more benzodiazepines before delirium onset (0.152 vs 0.045 mg/day, P = 0.040). Prolonged delirium (>1 day) was associated with similar factors. LOS positively correlated with delirium duration and sedative exposure, and inversely with hemoglobin and platelet counts.

Conclusions

Delirium in hospitalized cancer patients may reflect underlying physiological frailty that increases susceptibility to mortality from metabolic derangements, malnutrition, sepsis, and sedative exposure. Early identification of these high-risk clinical factors in cancer inpatients with delirium may help mitigate risks posed by these abnormalities.

Plain Language Summary

Delirium is a sudden state of confusion that affects memory, thinking, and awareness that more commonly affects hospitalized older patients. Patients who develop delirium are at increased risk for prolonged hospital stays, long-term functional deficits, and even death. Our study looked at 126 cancer patients who developed delirium while staying in the hospital. We investigated which factors among these cancer patients with delirium led to worse outcomes, such as extended hospital stays and mortality. We identified a variety of clinical factors that were associated with worse outcomes. Firstly, some of the factors we identified were abnormal laboratory values, such as albumin (a protein found in the blood) and platelets (cell fragments that help stop bleeding). Additionally, patients who died experienced longer-lasting delirium and higher instances of severe infection on average. Lastly, patients who died received more anti-anxiety medications with sedative effects while hospitalized. Due to the design of this study, we can only show associations between these factors and worse outcomes. In other words, we do not claim that any of these factors necessarily caused patients to die after they developed delirium. Instead, this study shows that beyond delirium alone, other markers remain indicators of poorer outcomes among hospitalized cancer patients who develop delirium. The results emphasize the importance of the early detection of clinical warning signs and the necessity to monitor which medications are being used in this vulnerable population.

Search results

Reporting on Adverse Clinical Events

Incident Delirium in Hospitalized Cancer Patients: Clinical Factors Associated With Mortality and Prolonged Hospitalization