Acute confusion in patients with systemic cancer.
OBJECTIVE
To determine the incidence, the causes and the prognostic value for survival of acute confusion (delirium) in patients admitted to a general cancer hospital.


METHODS
Hundred consecutive patients with confusion were examined; 78 had a metastatic disease, 11 had local tumor and 11 had no sign of tumor recurrence at admission. Patients with confusion represented 11.8% (95%CI: 9.7-14.2%) of admissions. Follow-up period lasted 18 months from the inclusion of the last patient.


RESULTS
Structural brain lesions (SBL) were mostly metastatic and caused confusion in 36 patients. 57 patients had a toxic or metabolic encephalopathy (TME). The cause remained unexplained in 6 cases, and in one patient the final diagnosis was psychotic state. Most patients with TME had more than one abnormality which could cause confusion. Confusion was reversible in 34 patients, and the odds for its regression was 3-fold higher in patients with TME (P = 0.02). Survival was significantly shorter (P = 0.02) in patients with SBL (median: 3 weeks) than in patients with TME (median: 8 weeks). However, the survival was significantly longer (P = 0.007) in patients with only one toxic or metabolic disorder (median: 20.5 weeks) than in patients with multiple changes (median: 5 weeks).


CONCLUSIONS
Confusion is common in general cancer population. TME is the leading etiology and it is due to multiple causes in most patients. SBL causes confusion in one third of the patients. Patients with TME have a greater chance to recover, and survive longer especially if they have only one toxic or metabolic change.
Doriath
V
V
Service de Médecine Interne, Institut Jules Bordet, 1 rue Héger Bordet, 1000 Bruxelles, Belgium. vdoriath@ulb.ac.be
Paesmans
M
M
Catteau
G
G
Hildebrand
J
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001928:Brain Diseases, Metabolic / Q000150:complications; D003693:Delirium / Q000209:etiology* / Q000628:therapy; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D020258:Neurotoxicity Syndromes / Q000150:complications; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate