Association between polypharmacy and the persistence of delirium: a retrospective cohort study
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RESEARCH
Open Access
Association between polypharmacy and the persistence of delirium: a retrospective cohort study Ken Kurisu1,2, Daisuke Miyabe1, Yoshiko Furukawa1, Osamu Shibayama1 and Kazuhiro Yoshiuchi2*
Abstract Background: Although the association between polypharmacy and the occurrence of delirium has been well studied, the influence of polypharmacy on the persistence of delirium remains unclear. We aimed to explore the effect of polypharmacy on the persistence of delirium. Methods: This retrospective cohort study was conducted at a tertiary hospital. The medical records of patients diagnosed with delirium who were referred to the Department of Psychosomatic Medicine were reviewed. Presentation with delirium on day 3 was set as the outcome in this study. We counted the number of drugs prescribed on the date of referral, excluding general infusion fluids, nutritional or electrolytic products, and psychotropics. To define polypharmacy, we developed a classification and regression tree (CART) model and drew a receiver operating characteristic (ROC) curve. The odds ratio (OR) of polypharmacy for the persistence of delirium on day 3 was calculated using a logistic regression model with the propensity score as a covariate. Results: We reviewed the data of 113 patients. The CART model and ROC curve indicated an optimal polypharmacy cutoff of six drugs. Polypharmacy was significantly associated with the persistence of delirium both before [OR, 3.02; 95% confidence interval (CI), 1.39–6.81; P = 0.0062] and after (OR, 3.19; 95% CI, 1.32–8.03; P = 0.011) propensity score adjustment. Conclusion: We discovered an association between polypharmacy and worsening courses of delirium and hypothesize that polypharmacy might be a prognostic factor for delirium. Keywords: Classification and regression tree, Delirium, Polypharmacy, Propensity score, Receiver operating characteristic curve
Background Delirium is an acute psychiatric disorder that is caused by physiological and/or pharmacological factors. The body-mind relation is strongly associated with its pathology, making both psychiatric and physiological interventions critical to its management [1].
* Correspondence: [email protected] 2 Department of Stress Sciences and Psychosomatic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan Full list of author information is available at the end of the article
Polypharmacy is a growing social issue worldwide. Inappropriate prescribing practices mainly contribute to its occurrence [2, 3]. It causes both physiological and psychological problems for patients with multiple morbidities [4, 5]. The association between polypharmacy and the incidence of delirium has been well studied [6–10] and a guideline recommends drug reviews for delirium prevention [11]. However, the influence of polypharmacy on the persistence of delirium has yet to be examined thoroughly. One retrospective study investigated the effect of
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