High Proportion of Thiamine Deficiency in Referred Cancer Patients with Delirium: a Retrospective Descriptive Study

Overview

Journal Eur J Clin Nutr

Specialty Nutritional Sciences

Date 2021 Jan 30

PMID 33514871

Citations 12

Authors

Hideki Onishi

Izumi Sato

Nozomu Uchida

Takao Takahashi

Daisuke Furuya

Yasuhiro Ebihara

Akira Yoshioka

Hiroshi Ito

Mayumi Ishida

Affiliations

Soon will be listed here.

Abstract

Background/objectives: Recent studies have revealed thiamine deficiency (TD) as a cause of delirium in cancer patients. However, the extent to which Wernicke encephalopathy is present and in what patients is not well understood.

Subjects/methods: In this retrospective descriptive study, we investigated referred cancer patients who were diagnosed with delirium by a psycho-oncologist to clarify the proportion of TD, the therapeutic effect of thiamine administration, and the factors involved in its onset.

Results: Among 71 patients diagnosed with delirium by a psycho-oncologist, TD was found in 45% of the patients. Intravenous administration of thiamine led to a recovery in about 60% of these patients. We explored the factors associated with TD using a multivariable regression model with a Markov chain Monte Carlo imputation procedure. We found an association between TD and chemotherapy (adjusted odds ratio, 1.98 [95% confidence interval, 1.04-3.77]); however, there were no significant associations between TD and the other factors we considered.

Conclusions: TD is not particularly rare in delirium patients undergoing psychiatric consultation. The delirium was resolved in more than half of these patients by intravenous administration of thiamine. Oncologists should consider TD as a cause of delirium in cancer patients. Further prospective study is needed to clarify the relationship between TD and delirium in cancer patients.

Citing Articles

Recent Advances on the Role of B Vitamins in Cancer Prevention and Progression.

Frost Z, Bakhit S, Amaefuna C, Powers R, Ramana K Int J Mol Sci. 2025; 26(5).

PMID: 40076592 PMC: 11900642. DOI: 10.3390/ijms26051967.

Associations of nutrition impact symptoms with depression in patients with advanced cancer.

Amano K, Okamura S, Matsuda Y, Baracos V, Mori N, Miura T Support Care Cancer. 2024; 32(7):445.

PMID: 38896133 DOI: 10.1007/s00520-024-08645-6.

Vitamin Nutritional Status in Patients with Pancreatic Cancer: A Narrative Review.

Azzini E, Furini T, Polito A, Scalfi L, Pinto A, Gasperi V Int J Mol Sci. 2024; 25(9).

PMID: 38732007 PMC: 11084158. DOI: 10.3390/ijms25094773.

Whole blood thiamine, intravenous thiamine supplementation and delirium occurrence in the intensive care unit: retrospective cohort analyses.

Mumin M, McKenzie C, Page V, Hadfield D, Aitken L, Hanks F Int J Clin Pharm. 2024; 46(3):631-638.

PMID: 38332207 DOI: 10.1007/s11096-023-01690-x.

Communication at the End of Life.

Onishi H J Hosp Palliat Care. 2023; 24(3):135-143.

PMID: 37674559 PMC: 10180059. DOI: 10.14475/jhpc.2021.24.3.135.

References

Wada T, Wada M, Wada M, Onishi H . Characteristics, interventions, and outcomes of misdiagnosed delirium in cancer patients. Palliat Support Care. 2010; 8(2):125-31. DOI: 10.1017/S1478951509990861. View

Onishi H, Ishida M, Kagamu H, Murayama Y, Kobayashi K, Sato I . Wernicke encephalopathy in a lung cancer patient during treatment with nivolumab. Palliat Support Care. 2018; 17(2):245-247. DOI: 10.1017/S1478951518000469. View

Isenberg-Grzeda E, Kutner H, Nicolson S . Wernicke-Korsakoff-syndrome: under-recognized and under-treated. Psychosomatics. 2012; 53(6):507-16. DOI: 10.1016/j.psym.2012.04.008. View

Aksoy M, Basu T, Brient J, Dickerson J . Thiamin status of patients treated with drug combinations containing 5-fluorouracil. Eur J Cancer (1965). 1980; 16(8):1041-5. DOI: 10.1016/0014-2964(80)90251-0. View

Galvin R, Brathen G, Ivashynka A, Hillbom M, Tanasescu R, Leone M . EFNS guidelines for diagnosis, therapy and prevention of Wernicke encephalopathy. Eur J Neurol. 2010; 17(12):1408-18. DOI: 10.1111/j.1468-1331.2010.03153.x. View

Sechi G, Sechi E, Fois C, Kumar N . Advances in clinical determinants and neurological manifestations of B vitamin deficiency in adults. Nutr Rev. 2016; 74(5):281-300. DOI: 10.1093/nutrit/nuv107. View

Victor M, Adams R, Collins G . The Wernicke-Korsakoff syndrome. A clinical and pathological study of 245 patients, 82 with post-mortem examinations. Contemp Neurol Ser. 1971; 7:1-206. View

Isenberg-Grzeda E, Hsu A, Hatzoglou V, Nelso C, Breitbart W . Palliative treatment of thiamine-related encephalopathy (Wernicke's encephalopathy) in cancer: A case series and review of the literature. Palliat Support Care. 2014; 13(5):1241-9. PMC: 4982657. DOI: 10.1017/S1478951514001163. View

Onishi H, Kawanishi C, Onose M, Yamada T, Saito H, Yoshida A . Successful treatment of Wernicke encephalopathy in terminally ill cancer patients: report of 3 cases and review of the literature. Support Care Cancer. 2004; 12(8):604-8. DOI: 10.1007/s00520-004-0637-y. View

10.

Onishi H, Ishida M, Toyama H, Tanahashi I, Ikebuchi K, Taji Y . Early detection and successful treatment of Wernicke encephalopathy in a patient with advanced carcinoma of the external genitalia during chemotherapy. Palliat Support Care. 2015; 14(3):302-6. DOI: 10.1017/S1478951515000875. View

11.

Maclean L, Rhode B, Shizgal H . Nutrition following gastric operations for morbid obesity. Ann Surg. 1983; 198(3):347-55. PMC: 1353306. DOI: 10.1097/00000658-198309000-00011. View

12.

Harper C, Gold J, Rodriguez M, Perdices M . The prevalence of the Wernicke-Korsakoff syndrome in Sydney, Australia: a prospective necropsy study. J Neurol Neurosurg Psychiatry. 1989; 52(2):282-5. PMC: 1032524. DOI: 10.1136/jnnp.52.2.282. View

13.

Oken M, Creech R, Tormey D, Horton J, Davis T, McFadden E . Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol. 1982; 5(6):649-55. View

14.

Harper C, Giles M, Finlay-Jones R . Clinical signs in the Wernicke-Korsakoff complex: a retrospective analysis of 131 cases diagnosed at necropsy. J Neurol Neurosurg Psychiatry. 1986; 49(4):341-5. PMC: 1028756. DOI: 10.1136/jnnp.49.4.341. View

15.

Barbato M, Rodriguez P . Thiamine deficiency in patients admitted to a palliative care unit. Palliat Med. 1994; 8(4):320-4. DOI: 10.1177/026921639400800408. View

16.

Sechi G, Serra A . Wernicke's encephalopathy: new clinical settings and recent advances in diagnosis and management. Lancet Neurol. 2007; 6(5):442-55. DOI: 10.1016/S1474-4422(07)70104-7. View

17.

Onishi H, Sugimasa Y, Kawanishi C, Onose M . Wernicke encephalopathy presented in the form of postoperative delirium in a patient with hepatocellular carcinoma and liver cirrhosis: a case report and review of the literature. Palliat Support Care. 2006; 3(4):337-40. DOI: 10.1017/s1478951505050510. View

18.

Inouye S . The dilemma of delirium: clinical and research controversies regarding diagnosis and evaluation of delirium in hospitalized elderly medical patients. Am J Med. 1994; 97(3):278-88. DOI: 10.1016/0002-9343(94)90011-6. View

19.

Pourhassan M, Biesalski H, Angersbach B, Lueg G, Klimek C, Wirth R . Prevalence of thiamine deficiency in older hospitalized patients. Clin Interv Aging. 2018; 13:2247-2250. PMC: 6220429. DOI: 10.2147/CIA.S183102. View

20.

Isenberg-Grzeda E, Shen M, Alici Y, Wills J, Nelson C, Breitbart W . High rate of thiamine deficiency among inpatients with cancer referred for psychiatric consultation: results of a single site prevalence study. Psychooncology. 2016; 26(9):1384-1389. PMC: 5124411. DOI: 10.1002/pon.4155. View