Impact of Pre-admission Central Nervous System Medication Use on Delirium in Hospitalized Patients with Advanced Cancer: A Multicenter, Prospective, Observational Study in Korea

This study investigated the impact of pre-admission central nervous system (CNS) medication use on delirium incidence, duration, and survival in hospitalized patients with advanced cancer. In this multicenter prospective study across four tertiary hospitals in South Korea, adults with advanced cancer were enrolled and categorized based on their use of CNS medications within 90 days preceding admission. Associations between pre-admission CNS medication use and outcomes (delirium incidence, delirium duration, and overall survival) were assessed using multivariable regression and Cox proportional hazards models. Of the 190 patients enrolled, 140 had used CNS medications prior to admission. Delirium occurred in 22.1% of the patients with CNS medication use versus 14.0% of those without (adjusted odds ratio [aOR]: 2.53, 95% confidence interval [CI]: 0.95-7.60; not significant). Opioid (aOR: 2.48, 95% CI: 1.01-6.61) and antidepressant (aOR: 5.58, 95% CI: 1.22-27.35) use were significantly associated with increased delirium risk. Use of three or more CNS medication classes was associated with a markedly high risk (aOR: 11.15, 95% CI: 2.13-64.17). Delirium duration did not differ significantly between groups. Patients with pre-admission CNS medication exposure exhibited shorter overall survival (adjusted hazard ratio [aHR]: 1.45, 95% CI: 1.01-2.09). Prior opioid use was also associated with increased mortality (aHR: 1.45, 95% CI: 1.03-2.05). Pre-admission exposure to CNS medication, particularly opioids and antidepressants, was associated with an increased risk of delirium in patients with advanced cancer. A thorough medication history review upon admission is crucial to identifying high-risk patients and implementing early preventive interventions.