Predictors of Mortality for Delirium in Palliative Care.
Delirium has a high mortality rate. Understanding predictors of prognosis in patients with delirium will aid treatment decisions and communication. This study aimed to explore variables associated with death during an established episode of delirium in palliative care when haloperidol treatment had been commenced.



A consecutive cohort of palliative care patients, from 14 centers across four countries, is reported. The outcome of interest was death within 14 days from commencement of haloperidol treatment for delirium. Clinicodemographic variables explored were delirium severity, age, gender, primary life limiting illness, body mass index (BMI), total daily haloperidol dose at baseline (mg), functional status, and comorbidities.



One hundred and sixteen palliative care patients where vital status was known were included in the analysis; 45% (n = 52) died within 10 days, and 56% (n = 65) died within 14 days. In multivariate analyses no clinical or demographic variables predicted death, apart from lower BMI in noncancer patients.



This study has shown a very high mortality rate within two weeks of commencing haloperidol for delirium in palliative care, with no clear clinical predictors for those with a higher chance of dying. Having a higher BMI offered some benefit in survival, but only in noncancer patients. When delirium occurs in advanced illness, discussion should be initiated about the gravity of the clinical situation.
1 Discipline of Palliative and Supportive Services, Flinders University , Adelaide, South Australia.|2 South West Sydney Clinical School, University of New South Wales , Sydney Australia .|3 Centre for Cardiovascular and Chronic Care, Faculty of Health, University of Technology Sydney , Ultimo, Australia .|4 Ingham Institute of Applied Medical Research , Sydney, Australia .
Meera R
MR
Agar
5 Flinders Clinical Effectiveness, Flinders University , Adelaide, Australia .
Stephen J
SJ
Quinn
6 Discipline of Medicine, University of Adelaide , Adelaide, Australia .|7 Northern Adelaide Local Health Network , Adelaide, Australia .
Gregory B
GB
Crawford
8 Department of Medicine, Division of Geriatrics, University of California San Francisco , San Francisco, California.|9 The Jewish Home of San Francisco, San Francisco, California.
Christine S
CS
Ritchie
3 Centre for Cardiovascular and Chronic Care, Faculty of Health, University of Technology Sydney , Ultimo, Australia .
Jane L
JL
Phillips
1 Discipline of Palliative and Supportive Services, Flinders University , Adelaide, South Australia.
Aileen
A
Collier
1 Discipline of Palliative and Supportive Services, Flinders University , Adelaide, South Australia.|5 Flinders Clinical Effectiveness, Flinders University , Adelaide, Australia .
David C
DC
Currow
D015897:Comorbidity; D003693:Delirium; D006220:Haloperidol; D006801:Humans; D010166:Palliative Care; D011379:Prognosis
D006220:Haloperidol