High proportion of thiamine deficiency in referred cancer patients with delirium: a retrospective descriptive study

• Published in: European journal of clinical nutrition Vol. 75; no. 10; pp. 1499 - 1505
• Main Authors: Onishi, Hideki, Sato, Izumi, Uchida, Nozomu, Takahashi, Takao, Furuya, Daisuke, Ebihara, Yasuhiro, Yoshioka, Akira, Ito, Hiroshi, Ishida, Mayumi
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.10.2021; Nature Publishing Group
• Subjects: 692/699/2743; 692/699/317; Cancer; Care and treatment; Chemotherapy; Clinical Nutrition; Confidence intervals; Delirium; Delirium - drug therapy; Delirium - epidemiology; Delirium - etiology; Epidemiology; Health aspects; Humans; Internal Medicine; Intravenous administration; Markov chains; Medicine; Medicine & Public Health; Mental disorders; Metabolic Diseases; Neoplasms - complications; Neoplasms - drug therapy; Public Health; Referral and Consultation; Regression models; Retrospective Studies; Statistical analysis; Thiamine; Thiamine Deficiency - complications; Thiamine Deficiency - drug therapy; Thiamine Deficiency - epidemiology; Vitamin B; Vitamin B1; Vitamin deficiency; Wernicke's encephalopathy; Japan
• ISSN: 0954-3007; 1476-5640
• DOI: 10.1038/s41430-021-00859-9

Background/Objectives Recent studies have revealed thiamine deficiency (TD) as a cause of delirium in cancer patients. However, the extent to which Wernicke encephalopathy is present and in what patients is not well understood. Subjects/Methods In this retrospective descriptive study, we investigated referred cancer patients who were diagnosed with delirium by a psycho-oncologist to clarify the proportion of TD, the therapeutic effect of thiamine administration, and the factors involved in its onset. Results Among 71 patients diagnosed with delirium by a psycho-oncologist, TD was found in 45% of the patients. Intravenous administration of thiamine led to a recovery in about 60% of these patients. We explored the factors associated with TD using a multivariable regression model with a Markov chain Monte Carlo imputation procedure. We found an association between TD and chemotherapy (adjusted odds ratio, 1.98 [95% confidence interval, 1.04–3.77]); however, there were no significant associations between TD and the other factors we considered. Conclusions TD is not particularly rare in delirium patients undergoing psychiatric consultation. The delirium was resolved in more than half of these patients by intravenous administration of thiamine. Oncologists should consider TD as a cause of delirium in cancer patients. Further prospective study is needed to clarify the relationship between TD and delirium in cancer patients.