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A decision tree prediction model for a short-term outcome of delirium in patients with advanced cancer receiving pharmacological interventions: A secondary analysis of a multicenter and prospective observational study (Phase-R)

Published online by Cambridge University Press:  30 September 2021

Ken Kurisu
Affiliation:
Department of Stress Sciences and Psychosomatic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Shuji Inada
Affiliation:
Department of Stress Sciences and Psychosomatic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Isseki Maeda
Affiliation:
Department of Palliative Care, Senri-Chuo Hospital, Toyonaka, Osaka, Japan
Asao Ogawa
Affiliation:
Department of Psycho-Oncology Service, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
Satoru Iwase
Affiliation:
Department of Palliative Medicine, Saitama Medical University, Iruma, Saitama, Japan
Tatsuo Akechi
Affiliation:
Center for Psycho-Oncology and Palliative Care, Nagoya City University Hospital, Nagoya, Aichi, Japan Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Aichi, Japan
Tatsuya Morita
Affiliation:
Department of Palliative and Supportive Care, Palliative Care Team, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
Shunsuke Oyamada
Affiliation:
Department of Biostatistics, JORTC Data Center, Tokyo, Japan
Takuhiro Yamaguchi
Affiliation:
Division of Biostatistics, Tohoku University School of Medicine, Sendai, Japan
Kengo Imai
Affiliation:
Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
Rika Nakahara
Affiliation:
Department of Psycho-Oncology, National Cancer Center Hospital, Tokyo, Japan
Keisuke Kaneishi
Affiliation:
Department of Palliative Care Unit, JCHO Tokyo Shinjuku Medical Center, Tokyo, Japan
Nobuhisa Nakajima
Affiliation:
Division of Community Medicine and Internal Medicine, University of the Ryukyus Hospital, Okinawa, Japan
Masahiko Sumitani
Affiliation:
Department of Pain and Palliative Medicine, The University of Tokyo Hospital, Tokyo, Japan
Kazuhiro Yoshiuchi*
Affiliation:
Department of Stress Sciences and Psychosomatic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
*
Author for correspondence: Kazuhiro Yoshiuchi, Department of Stress Sciences and Psychosomatic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. E-mail: kyoshiuc-tky@umin.ac.jp

Abstract

Objective

There is no widely used prognostic model for delirium in patients with advanced cancer. The present study aimed to develop a decision tree prediction model for a short-term outcome.

Method

This is a secondary analysis of a multicenter and prospective observational study conducted at 9 psycho-oncology consultation services and 14 inpatient palliative care units in Japan. We used records of patients with advanced cancer receiving pharmacological interventions with a baseline Delirium Rating Scale Revised-98 (DRS-R98) severity score of ≥10. A DRS-R98 severity score of <10 on day 3 was defined as the study outcome. The dataset was randomly split into the training and test dataset. A decision tree model was developed using the training dataset and potential predictors. The area under the curve (AUC) of the receiver operating characteristic curve was measured both in 5-fold cross-validation and in the independent test dataset. Finally, the model was visualized using the whole dataset.

Results

Altogether, 668 records were included, of which 141 had a DRS-R98 severity score of <10 on day 3. The model achieved an average AUC of 0.698 in 5-fold cross-validation and 0.718 (95% confidence interval, 0.627–0.810) in the test dataset. The baseline DRS-R98 severity score (cutoff of 15), hypoxia, and dehydration were the important predictors, in this order.

Significance of results

We developed an easy-to-use prediction model for the short-term outcome of delirium in patients with advanced cancer receiving pharmacological interventions. The baseline severity of delirium and precipitating factors of delirium were important for prediction.

Type
Original Article
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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