Impact of delirium on in-patient outcomes in patients with pancreatic cancer: A nationwide study.
Authors: Nabi Waseem , Javaid Saad , Ahmad Shahzaib , Ganiyani Mohammad Arfat , Aziz Nouman , Garje Rohan , Seetaram Karthik , Anwar Waqas , Usama Ali , Zia Mehwish , Nahidi Seyed Mohammad 
Published: July 2024

e16369

Background: Pancreatic cancer is the fourth leading cause of cancer-related death in the United States. Anecdotal evidence suggests that delirium, characterized by a state of disorientation and confusion, is associated with adverse clinical outcomes, especially in aggressive diseases like cancer. We aim to analyze the impact of delirium on outcomes in patients hospitalized with pancreatic cancer. Methods: The National Inpatient Sample (2017-2020) was employed to identify patients who were admitted with a primary diagnosis of pancreatic cancer. Multivariate regression analysis was employed and the results of this study were reported adhering to the STROBE guidelines. Our primary outcome was inpatient mortality in patients with pancreatic cancer with and without a concurrent diagnosis of delirium. The secondary outcomes included the length of hospital stay, the total cost of hospitalization, and clinical complications or outcomes such as Fluid and Electrolyte Disorders, AKI, Major Depressive Disorder, etc. Baseline characteristics were comparable between patients in either group. Results: A total of 149525 patients had a diagnosis of pancreatic cancer, among which 1850 had concurrent delirium. The mean age of patients with and without delirium was 72.92±SD vs 68.24±SD years, respectively ( p = 0.004). Patients with delirium were found to have higher odds of in-patient mortality (OR = 3.89, 95% CI: 2.78- 5.44 , p < 0.001). Length of stay and total hospitalization cost were also significantly increased in patients with concurrent delirium (+6.69 days, 95% CI 5.32-8.05, P < 0.001 and + USD 104355, 95% CI 71358- 137352 , p < 0.001, respectively). Similarly, pancreatic cancer patients with delirium had increased likelihood of fluid and electrolyte imbalance (OR = 1.51 95% CI 1.19-1.90, p < 0.001), acute kidney injury (OR = 2.31, 95% CI 1.76-3.04, p < 0.001), major depressive disorder (OR = 1.46, 95% CI 1.06-2.01, p = 0.02), anxiety (OR = 2.19, 95% CI 1.67-2.88, p < 0.001), dementia (OR = 5.58, 95% CI 4.10-7.59, p < 0.001), pneumonia (OR = 1.99, 95% CI 1.19-3.33, p = 0.008), sepsis (OR = 3.13, 95% CI 2.13-4.61, p < 0.001), acute respiratory failure (OR = 3.05, 95% CI 2.16-4.31, p < 0.001), ICU admission (OR = 3.31, 95% CI 2.34-4.68, p < 0.001), mechanical ventilation (OR = 3.79, 95% CI 2.57-5.59, p < 0.001), vasopressor use (OR = 2.62, 95% CI 1.34-5.11, p = 0.004), cardiac arrest (OR = 2.50, 95% CI 1.05-6.24 , p = 0.04). Conclusions: Delirium in hospitalized patients with pancreatic cancer results in worse clinical outcomes and is an independent predictor of mortality. It is associated with a four-fold increase in mortality and a significant increase in length of stay, total cost of hospitalization and worse clinical outcomes. Appropriate management of delirium in patients with pancreatic carcinoma is therefore crucial for decreasing morbidity and mortality among these patients.