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암환자 섬망의 중증도와 사망위험도의 관계

Relationship Between Severity of Delirium and Mortality in Patients with Cancer

김재민|김용환|윤진상|김선영|김성완|신일선|장지은
대한생물치료정신의학회 (Korean Society Of Biological Therapies In Psychiatry)|2011.06|생물치료정신의학 (Journal of the Korean Society of Biological Therapies in Psychiatry)|제17권 제1호|pp. 131-139

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참고문헌

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암·섬망·K-DRS-R-98·사망위험도·사망률Cancer · Delirium · K-DRS-R-98 · Mortality
주제분류정신과학

초록

Objectives：To assess the association between severity of delirium and mortality in cancer patients and to investigate the phenomenology of delirium among those facing imminent death. Methods：We retrospectively reviewed the charts of 112 cancer patients with delirium at a cancer center. The subjects were categorized into three groups(deceased before discharge, discharged without hope for improvement, and improved). Severity of delirium was assessed using Korean version of the Delirium Rating Scale-Revised-98(K-DRS-R-98), and the scores of the three groups were compared after adjusting for the demographic and clinical factors that differed in the univariate analyses(p＜0.1). Results：Of the 112 patients, 20(17.9%) died prior to discharge, 28(25.0%) were discharged without hope for improvement, and 64(57.1%) improved during the index admission period. We found a significant difference in the total K-DRS-R-98 scores of the three groups(24.2, 26.1, and 21.2, respectively, p=0.002), which was maintained after adjusting for potential confounding factors(age, abnormality of white blood cell counts, and use of antibiotics and opioids). The total K-DRS-R-98 scores in the post-hoc analyses were significantly higher in the deceased-before-discharge and discharged-without-hope-for-improvement groups than in the improved group(p=0.017 and ＜0.001, respectively). According to scores on the K-DRS-R-98, sleep-wake cycle disturbances, language and cognitive abnormalities, and difficulties with attention, short-term memory, and visuospatial abilities were more frequent in cancer patients in the deceased-before-discharge and discharged-without-hope groups than in the improved group. Conclusion：The severity of delirium at the time of psychiatric consultation was significantly associated with mortality in cancer patients with delirium.

Abstract

Objectives：To assess the association between severity of delirium and mortality in cancer patients and to investigate the phenomenology of delirium among those facing imminent death. Methods：We retrospectively reviewed the charts of 112 cancer patients with delirium at a cancer center. The subjects were categorized into three groups(deceased before discharge, discharged without hope for improvement, and improved). Severity of delirium was assessed using Korean version of the Delirium Rating Scale-Revised-98(K-DRS-R-98), and the scores of the three groups were compared after adjusting for the demographic and clinical factors that differed in the univariate analyses(p＜0.1). Results：Of the 112 patients, 20(17.9%) died prior to discharge, 28(25.0%) were discharged without hope for improvement, and 64(57.1%) improved during the index admission period. We found a significant difference in the total K-DRS-R-98 scores of the three groups(24.2, 26.1, and 21.2, respectively, p=0.002), which was maintained after adjusting for potential confounding factors(age, abnormality of white blood cell counts, and use of antibiotics and opioids). The total K-DRS-R-98 scores in the post-hoc analyses were significantly higher in the deceased-before-discharge and discharged-without-hope-for-improvement groups than in the improved group(p=0.017 and ＜0.001, respectively). According to scores on the K-DRS-R-98, sleep-wake cycle disturbances, language and cognitive abnormalities, and difficulties with attention, short-term memory, and visuospatial abilities were more frequent in cancer patients in the deceased-before-discharge and discharged-without-hope groups than in the improved group. Conclusion：The severity of delirium at the time of psychiatric consultation was significantly associated with mortality in cancer patients with delirium.

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