Whole blood thiamine (WBT) and delirium occurrencein the Intensive Care Unit (ICU)

Abstract

Introduction: thiamine di-phosphate (TDP) is an essential cofactor inglucose metabolism, glutamate transformation and in cholinesterase activity, all reported in delirium occurrence [1]. We proposed that adeficiency in Whole Blood Thiamine (WBT) could increase risk of delirium occurrence in patients admitted to the Intensive Care Unit (ICU).

Objectives: to establish whether there is a relationship between deficiency in WBT and ICU delirium occurrence in a cohort of ICU admissions from Gelre Hospital, Netherlands.

Methods. an anonymised patient dataset was approved and obtained from Gelre ICU. This was a secondary analysis of a previous study on WBT in ICU patients (2). Delirium was assessed twice a day, using confusion assessment method-intensive care unit (CAM-ICU). A day indelirium was defined as 1 or more positive CAM-ICU scores in 24 h.The pathology range for WBT deficiency was ≤ 100 nmol/litre. An initial analysis was carried out to explore whether normal levels of WBT at t-0 h, t24 hrs or t48 hrs resulted in a lower incidence of delirium during ICU admission. The analysis is reported as odds ratio (OR) and 95%confidence interval (CI).

Results: the original ICU patient cohort was admitted between 2009to 2010. There were 57 patients and WBT was reported at t-0, t-24and t-48. Analysis reported a comarable rate of delirium in those with normal WBT (> 100 nmol/litre) compared to those that were WBT deficient(≤ 100 nmol/litre) at t-0, t-24 and t-48, (OR: 0.68 [95% confidence interval (CI): 0.23–1.97]), (OR: 0.63 [95% CI: 0.20–2.00]) and (OR: 0.70[95% CI: 0.21–2.31]) respectively. Regression analysis was performed with age and sepsis as confounding variables, no significant differences were observed.

[Table 1. Relationship between WBT on ICU admission, t-24 h, t-48 h and delirium occurrence in ICU not included].

Conclusion: in this small dateset, no relationship could be detected
between WBT and delirium occurrence on ICU admission, and 24 and
48 h post admission. The lack of significance with regards to confounding
variable of sepsis and age could be attributed to small patient
numbers. Further analysis with a larger dataset is needed to investigate
the research question.

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Identifiers

ORCID for Cathrine McKenzie: orcid.org/0000-0002-5190-9711

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