Incidence of Delirium during the Initiation Phase of Morphine and Hydromorphone Therapy in Cancer Patients: A Retrospective Comparative Study
Bibliographic record
Abstract
Background: Opioids are known to induce delirium, and the incidence of delirium induced by individual opioids has been investigated. However, only a limited number of studies have examined the incidence of delirium induced by oral hydromorphone. Objective: To investigate whether differences exist in the incidence of delirium associated with oral morphine and oral hydromorphone during the initiation phase of treatment. Methods: The participants were opioid-naive inpatients with cancer who started oral morphine or oral hydromorphone at Shizuoka Cancer Center (in Shizuoka, Japan) between June 2017 and November 2020. The incidence of delirium in the first week of opioid use was compared between the 2 groups. Results: A total of 90 patients met the inclusion criteria, 27 who received oral hydromorphone and 63 who received oral morphine. The incidence rate of delirium in the oral hydromorphone group tended to be higher (19%, 5/27) than in the oral morphine group (8%, 5/63), although the difference was not statistically significant (odds ratio 0.4, 95% confidence interval, 0.1–1.4, p = 0.16 by the Fisher exact test). Propensity score matching was used to control for differences in patient background as confounders in the development of delirium, following which the incidence rate of delirium remained higher, but not significantly so, in the oral hydromorphone group (11%, 2/19) than in the oral morphine group (5%, 1/19) (odds ratio 0.5, 95% confidence interval 0.04–5.7, p > 0.99 by the Fisher exact test). Conclusions: There was no statistically significant difference in the incidence of delirium between those who received morphine and those who received hydromorphone, which suggests that for opioid-naive inpatients with cancer, oral hydromorphone can be used in a manner similar to that for oral morphine. Keywords: delirium, oral opioids, morphine, hydromorphone RÉSUMÉ Contexte : Les opioïdes sont connus pour induire un délire, et l’incidence du délire induit par des opioïdes individuels a fait l’objet d’études. Cependant, seul un nombre limité de celles-ci s’est penché sur l’incidence du délire induit par l’hydromorphone orale. Objectif : Étudier s’il existe des différences dans l’incidence du délire associé à la morphine orale et à l’hydromorphone orale pendant la phase d’initiation du traitement. Méthodologie : La population à l’étude se composait de patients hospitalisés naïfs aux opioïdes atteints de cancer; ils ont commencé à prendre de la morphine orale ou de l’hydromorphone orale au Shizuoka Cancer Center (à Shizuoka, au Japon) entre juin 2017 et novembre 2020. L’incidence du délire au cours de la première semaine de consommation d’opioïdes a été comparée entre les 2 groupes. Résultats : Au total, 90 patients répondaient aux critères d’inclusion : 27 avaient reçu de l’hydromorphone et 63 de la morphine. Le taux d’incidence du délire dans le groupe « hydromorphone orale » avait tendance à être plus élevé (19 %, 5/27) que dans le groupe « morphine orale » (8 %, 5/63), bien que la différence ne soit pas statistiquement significative (rapport de cotes [RC] 0,4, intervalle de confiance [IC] à 95 %, 0,1-1,4, p = 0,16 par le test exact de Fisher). L’appariement par score de propension a été utilisé pour contrôler les différences dans les antécédents des patients comme facteurs de confusion dans le développement du délire, après quoi le taux d’incidence du délire est resté plus élevé, mais pas de manière significative, dans le groupe « hydromorphone orale » (11 %, 2/19) que dans le groupe « morphine orale » (5 %, 1/19) (RC 0,5, IC à 95 % 0,04-5,7, p > 0,99 par le test exact de Fisher. Conclusions : Aucune différence statistiquement significative dans l’incidence du délire entre les personnes ayant reçu de la morphine et celles ayant reçu de l’hydromorphone n’a été observée. Cela laisse supposer que pour les patients hospitalisés naïfs aux opioïdes atteints de cancer, l’hydromorphone orale peut être utilisée d’une manière similaire à l’utilisation de la morphine orale. Mots-clés : délire, opioïdes oraux, morphine, hydromorphone
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".