Supratherapeutic Psychotropic Drug Levels in the Emergency Department and Their Association with Delirium Duration: A Preliminary Study.
Academic Medical Centers
/ statistics & numerical data
Aged
Aged, 80 and over
Biomarkers
/ blood
Delirium
/ blood
Emergency Service, Hospital
Female
Follow-Up Studies
Geriatric Assessment
/ methods
Humans
Male
Prognosis
Prospective Studies
Psychotropic Drugs
/ pharmacokinetics
Risk Factors
Tandem Mass Spectrometry
Time Factors
adverse drug reactions
delirium
liquid chromatography-tandem mass spectrometry
older adults
Journal
Journal of the American Geriatrics Society
ISSN: 1532-5415
Titre abrégé: J Am Geriatr Soc
Pays: United States
ID NLM: 7503062
Informations de publication
Date de publication:
11 2019
11 2019
Historique:
received:
11
04
2019
revised:
03
07
2019
accepted:
05
07
2019
pubmed:
11
9
2019
medline:
22
5
2020
entrez:
11
9
2019
Statut:
ppublish
Résumé
Polypharmacy is associated with delirium, but the mechanisms for this connection are unclear. Our goal was to determine the frequency of supratherapeutic psychotropic drug levels (SPDLs) in older hospitalized patients and if it is associated with the duration of emergency department (ED) delirium. Secondary analysis of a prospective cohort study. Tertiary care academic medical center. ED patients 65 years or older who were admitted to the hospital. Delirium was assessed in the ED and during the first 7 days of hospitalization using the modified Brief Confusion Assessment Method. Drug concentrations were determined in serum samples collected at enrollment via a novel platform based on liquid chromatography-tandem mass spectrometry capable of identifying and quantitating 78 clinically approved medications including opioids, benzodiazepines, antidepressants, antipsychotics, and amphetamines. Patients with serum psychotropic drug concentrations above established reference ranges were considered supratherapeutic and have a SPDL. We performed proportional odds logistic regression to determine if SPDLs were associated with ED delirium duration adjusted for confounders. Medical record review was performed to determine if the doses of medications associated with SPDLs were adjusted at hospital discharge. A total of 158 patients were enrolled; of these, 66 were delirious in the ED. SPDLs were present in 11 (17%) of the delirious and 4 (4%) of the non-delirious ED patients. SPDLs were significantly associated with longer ED delirium duration (adjusted proportional odds ratio = 6.0; 95% confidence interval = 2.1-17.3) after adjusting for confounders. Of the 15 medications associated with SPDLs, 9 (60%) were prescribed at the same or higher doses at the time of hospital discharge. SPDLs significantly increased the odds of prolonged ED delirium episodes. Approximately half of the medications associated with SPDLs were continued after hospital discharge at the same or higher doses. J Am Geriatr Soc 67:2387-2392, 2019.
Identifiants
pubmed: 31503339
doi: 10.1111/jgs.16156
pmc: PMC7029781
mid: NIHMS1065573
doi:
Substances chimiques
Biomarkers
0
Psychotropic Drugs
0
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
2387-2392Subventions
Organisme : NCATS NIH HHS
ID : UL1 TR000445
Pays : United States
Organisme : NIA NIH HHS
ID : R01 AG053264
Pays : United States
Organisme : NCRR NIH HHS
ID : UL1 RR024975-01
Pays : United States
Organisme : NIA NIH HHS
ID : K23AG032355
Pays : United States
Organisme : NCRR NIH HHS
ID : UL1 RR024975
Pays : United States
Organisme : NIA NIH HHS
ID : K23 AG032355
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR000445-06
Pays : United States
Organisme : National Institutes of Health (NIH)
ID : R01AG053264
Pays : International
Organisme : National Institutes of Health (NIH)
ID : R01AG058639
Pays : International
Organisme : NIA NIH HHS
ID : R01 AG058639
Pays : United States
Organisme : Veteran Affairs Geriatric Research, Education, and Clinical Center (GRECC)
Pays : International
Informations de copyright
© 2019 The American Geriatrics Society.
Références
Psychopharmacology (Berl). 1982;78(1):25-7
pubmed: 6815692
Biopharm Drug Dispos. 1999 Nov;20(8):369-77
pubmed: 10870093
J Am Med Dir Assoc. 2014;15(11):850.e11-5
pubmed: 25405712
JAMA. 2001 Dec 5;286(21):2703-10
pubmed: 11730446
Int Rev Psychiatry. 2013 Oct;25(5):494-508
pubmed: 24151798
Acad Emerg Med. 2006 May;13(5):530-6
pubmed: 16551775
J Am Geriatr Soc. 2017 Jun;65(6):1333-1338
pubmed: 28263444
Crit Care. 2012 Jul 26;16(4):R136
pubmed: 22835221
Clin Chem. 1988 May;34(5):822-8
pubmed: 3131042
Pharmacopsychiatry. 2018 Jan;51(1-02):9-62
pubmed: 28910830
Ann Emerg Med. 2010 Sep;56(3):244-252.e1
pubmed: 20363527
Psychosomatics. 2009 May-Jun;50(3):234-8
pubmed: 19567762
ACS Chem Neurosci. 2017 Aug 16;8(8):1641-1644
pubmed: 28640591
Am J Emerg Med. 2016 Jun;34(6):1031-6
pubmed: 27021131
Ther Drug Monit. 2000 Aug;22(4):446-54
pubmed: 10942186
Acad Emerg Med. 2009 Mar;16(3):193-200
pubmed: 19154565
Psychol Med. 1994 Feb;24(1):145-53
pubmed: 8208879
Age Ageing. 2011 Jan;40(1):23-9
pubmed: 21068014
Ther Drug Monit. 1982;4(1):17-25
pubmed: 7041335
Pharmacopsychiatry. 2011 Sep;44(6):195-235
pubmed: 21969060
J Neuropsychiatry Clin Neurosci. 1993 Summer;5(3):322-9
pubmed: 8369643
JAMA. 2007 Jun 6;297(21):2391-404
pubmed: 17551132
Int J Neuropsychopharmacol. 1999 Mar;2(1):17-23
pubmed: 11281966
Crit Care Med. 1985 Oct;13(10):818-29
pubmed: 3928249
Psychosomatics. 2002 May-Jun;43(3):183-94
pubmed: 12075033
Ann Emerg Med. 2003 May;41(5):678-84
pubmed: 12712035
BMC Med. 2016 Jul 18;14:106
pubmed: 27430902
ACS Chem Neurosci. 2018 Mar 21;9(3):555-562
pubmed: 29155555