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

Muhammad A Mumin; Cathrine A McKenzie; Valerie J Page; Daniel Hadfield; Leanne M Aitken; Fraser Hanks; Emma Cunningham; Bronagh Blackwood; Edwin Van Dellen; Arjen J C Slooter; Michael P W Grocott; Daniel F McAuley; Peter E Spronk

doi:10.1007/s11096-023-01690-x

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

Muhammad A Mumin, Cathrine A McKenzie, Valerie J Page, Daniel Hadfield, Leanne M Aitken, Fraser Hanks, Emma Cunningham, Bronagh Blackwood, Edwin Van Dellen, Arjen J C Slooter, Michael P W Grocott, Daniel F McAuley, Peter E Spronk

Research output: Contribution to journal › Article › peer-review

Abstract

BACKGROUND: Thiamine di-phosphate is an essential cofactor in glucose metabolism, glutamate transformation and acetylcholinesterase activity, pathways associated with delirium occurrence. We hypothesised that a deficiency in whole blood thiamine and intravenous thiamine supplementation could impact delirium occurrence.

AIM: To establish whether a deficiency in whole blood thiamine and/or intravenous thiamine supplementation within 72 h of intensive care admission is associated with delirium occurrence.

METHOD: The first dataset was secondary analysis of a previous study in an intensive care unit in the Netherlands, reported in 2017. The second dataset contained consecutive intensive care admissions 2 years before (period 1: October 2014 to October 2016) and after (period 2: April 2017 to April 2019) routine thiamine supplementation was introduced within 72 h of admission. Delirium was defined as a positive Confusion Assessment Method-Intensive Care Unit score(s) in 24 h.

RESULTS: Analysis of the first dataset (n = 57) using logistic regression showed no relationship between delirium and sepsis or whole blood thiamine, but a significant association with age (p = 0.014). In the second dataset (n = 3074), 15.1% received IV thiamine in period 1 and 62.6% during period 2. Hierarchical regression analysis reported reduction in delirium occurrence in the second period; this did not reach statistical significance, OR = 0.81 (95% CI 0.652-1.002); p = 0.052.

CONCLUSION: No relationship was detected between whole blood thiamine and delirium occurrence on admission, at 24 and 48 h. It remains unclear whether routine intravenous thiamine supplementation during intensive care admission impacts delirium occurrence. Further prospective randomised clinical trials are needed.

Original language	English
Pages (from-to)	631-638
Number of pages	8
Journal	International Journal of Clinical Pharmacy
Volume	46
Issue number	3
Early online date	8 Feb 2024
DOIs	https://doi.org/10.1007/s11096-023-01690-x
Publication status	Published - Jun 2024

Bibliographical note

Funding Information:
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: M.A.M. declared a predoctoral clinical and practitioner academic fellowship (PCAF) funded by National Institute for Health and Care Research NIHR302686. C.A.M. reported receiving an honorarium for her work as editor in chief for Critical Illness ( www.medicinescomplete.com ) published by the Pharmaceutical Press (London). C.A.M. also reported receiving unrestricted research funding by National Institute of Health and Social Care Research (NIHR) Wessex Applied Research Collaborative (ARC).

Publisher Copyright:
© Crown 2024.

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10.1007/s11096-023-01690-x

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Mumin, M. A., McKenzie, C. A., Page, V. J., Hadfield, D., Aitken, L. M., Hanks, F., Cunningham, E., Blackwood, B., Van Dellen, E., Slooter, A. J. C., Grocott, M. P. W., McAuley, D. F., & Spronk, P. E. (2024). Whole blood thiamine, intravenous thiamine supplementation and delirium occurrence in the intensive care unit: retrospective cohort analyses. International Journal of Clinical Pharmacy, 46(3), 631-638. https://doi.org/10.1007/s11096-023-01690-x

Mumin, Muhammad A ; McKenzie, Cathrine A ; Page, Valerie J ; Hadfield, Daniel ; Aitken, Leanne M ; Hanks, Fraser ; Cunningham, Emma ; Blackwood, Bronagh ; Van Dellen, Edwin ; Slooter, Arjen J C ; Grocott, Michael P W ; McAuley, Daniel F ; Spronk, Peter E. / Whole blood thiamine, intravenous thiamine supplementation and delirium occurrence in the intensive care unit : retrospective cohort analyses. In: International Journal of Clinical Pharmacy. 2024 ; Vol. 46, No. 3. pp. 631-638.

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

abstract = "BACKGROUND: Thiamine di-phosphate is an essential cofactor in glucose metabolism, glutamate transformation and acetylcholinesterase activity, pathways associated with delirium occurrence. We hypothesised that a deficiency in whole blood thiamine and intravenous thiamine supplementation could impact delirium occurrence.AIM: To establish whether a deficiency in whole blood thiamine and/or intravenous thiamine supplementation within 72 h of intensive care admission is associated with delirium occurrence.METHOD: The first dataset was secondary analysis of a previous study in an intensive care unit in the Netherlands, reported in 2017. The second dataset contained consecutive intensive care admissions 2 years before (period 1: October 2014 to October 2016) and after (period 2: April 2017 to April 2019) routine thiamine supplementation was introduced within 72 h of admission. Delirium was defined as a positive Confusion Assessment Method-Intensive Care Unit score(s) in 24 h.RESULTS: Analysis of the first dataset (n = 57) using logistic regression showed no relationship between delirium and sepsis or whole blood thiamine, but a significant association with age (p = 0.014). In the second dataset (n = 3074), 15.1% received IV thiamine in period 1 and 62.6% during period 2. Hierarchical regression analysis reported reduction in delirium occurrence in the second period; this did not reach statistical significance, OR = 0.81 (95% CI 0.652-1.002); p = 0.052.CONCLUSION: No relationship was detected between whole blood thiamine and delirium occurrence on admission, at 24 and 48 h. It remains unclear whether routine intravenous thiamine supplementation during intensive care admission impacts delirium occurrence. Further prospective randomised clinical trials are needed.",

author = "Mumin, {Muhammad A} and McKenzie, {Cathrine A} and Page, {Valerie J} and Daniel Hadfield and Aitken, {Leanne M} and Fraser Hanks and Emma Cunningham and Bronagh Blackwood and {Van Dellen}, Edwin and Slooter, {Arjen J C} and Grocott, {Michael P W} and McAuley, {Daniel F} and Spronk, {Peter E}",

note = "Funding Information: The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: M.A.M. declared a predoctoral clinical and practitioner academic fellowship (PCAF) funded by National Institute for Health and Care Research NIHR302686. C.A.M. reported receiving an honorarium for her work as editor in chief for Critical Illness ( www.medicinescomplete.com ) published by the Pharmaceutical Press (London). C.A.M. also reported receiving unrestricted research funding by National Institute of Health and Social Care Research (NIHR) Wessex Applied Research Collaborative (ARC). Publisher Copyright: {\textcopyright} Crown 2024.",

year = "2024",

month = jun,

doi = "10.1007/s11096-023-01690-x",

language = "English",

volume = "46",

pages = "631--638",

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Mumin, MA, McKenzie, CA, Page, VJ, Hadfield, D, Aitken, LM, Hanks, F, Cunningham, E, Blackwood, B, Van Dellen, E, Slooter, AJC, Grocott, MPW, McAuley, DF & Spronk, PE 2024, 'Whole blood thiamine, intravenous thiamine supplementation and delirium occurrence in the intensive care unit: retrospective cohort analyses', International Journal of Clinical Pharmacy, vol. 46, no. 3, pp. 631-638. https://doi.org/10.1007/s11096-023-01690-x

Whole blood thiamine, intravenous thiamine supplementation and delirium occurrence in the intensive care unit : retrospective cohort analyses. / Mumin, Muhammad A; McKenzie, Cathrine A; Page, Valerie J; Hadfield, Daniel; Aitken, Leanne M; Hanks, Fraser; Cunningham, Emma; Blackwood, Bronagh; Van Dellen, Edwin; Slooter, Arjen J C; Grocott, Michael P W; McAuley, Daniel F; Spronk, Peter E.

In: International Journal of Clinical Pharmacy, Vol. 46, No. 3, 06.2024, p. 631-638.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Whole blood thiamine, intravenous thiamine supplementation and delirium occurrence in the intensive care unit

T2 - retrospective cohort analyses

AU - Mumin, Muhammad A

AU - McKenzie, Cathrine A

AU - Page, Valerie J

AU - Hadfield, Daniel

AU - Aitken, Leanne M

AU - Hanks, Fraser

AU - Cunningham, Emma

AU - Blackwood, Bronagh

AU - Van Dellen, Edwin

AU - Slooter, Arjen J C

AU - Grocott, Michael P W

AU - McAuley, Daniel F

AU - Spronk, Peter E

N1 - Funding Information: The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: M.A.M. declared a predoctoral clinical and practitioner academic fellowship (PCAF) funded by National Institute for Health and Care Research NIHR302686. C.A.M. reported receiving an honorarium for her work as editor in chief for Critical Illness ( www.medicinescomplete.com ) published by the Pharmaceutical Press (London). C.A.M. also reported receiving unrestricted research funding by National Institute of Health and Social Care Research (NIHR) Wessex Applied Research Collaborative (ARC). Publisher Copyright: © Crown 2024.

PY - 2024/6

Y1 - 2024/6

N2 - BACKGROUND: Thiamine di-phosphate is an essential cofactor in glucose metabolism, glutamate transformation and acetylcholinesterase activity, pathways associated with delirium occurrence. We hypothesised that a deficiency in whole blood thiamine and intravenous thiamine supplementation could impact delirium occurrence.AIM: To establish whether a deficiency in whole blood thiamine and/or intravenous thiamine supplementation within 72 h of intensive care admission is associated with delirium occurrence.METHOD: The first dataset was secondary analysis of a previous study in an intensive care unit in the Netherlands, reported in 2017. The second dataset contained consecutive intensive care admissions 2 years before (period 1: October 2014 to October 2016) and after (period 2: April 2017 to April 2019) routine thiamine supplementation was introduced within 72 h of admission. Delirium was defined as a positive Confusion Assessment Method-Intensive Care Unit score(s) in 24 h.RESULTS: Analysis of the first dataset (n = 57) using logistic regression showed no relationship between delirium and sepsis or whole blood thiamine, but a significant association with age (p = 0.014). In the second dataset (n = 3074), 15.1% received IV thiamine in period 1 and 62.6% during period 2. Hierarchical regression analysis reported reduction in delirium occurrence in the second period; this did not reach statistical significance, OR = 0.81 (95% CI 0.652-1.002); p = 0.052.CONCLUSION: No relationship was detected between whole blood thiamine and delirium occurrence on admission, at 24 and 48 h. It remains unclear whether routine intravenous thiamine supplementation during intensive care admission impacts delirium occurrence. Further prospective randomised clinical trials are needed.

AB - BACKGROUND: Thiamine di-phosphate is an essential cofactor in glucose metabolism, glutamate transformation and acetylcholinesterase activity, pathways associated with delirium occurrence. We hypothesised that a deficiency in whole blood thiamine and intravenous thiamine supplementation could impact delirium occurrence.AIM: To establish whether a deficiency in whole blood thiamine and/or intravenous thiamine supplementation within 72 h of intensive care admission is associated with delirium occurrence.METHOD: The first dataset was secondary analysis of a previous study in an intensive care unit in the Netherlands, reported in 2017. The second dataset contained consecutive intensive care admissions 2 years before (period 1: October 2014 to October 2016) and after (period 2: April 2017 to April 2019) routine thiamine supplementation was introduced within 72 h of admission. Delirium was defined as a positive Confusion Assessment Method-Intensive Care Unit score(s) in 24 h.RESULTS: Analysis of the first dataset (n = 57) using logistic regression showed no relationship between delirium and sepsis or whole blood thiamine, but a significant association with age (p = 0.014). In the second dataset (n = 3074), 15.1% received IV thiamine in period 1 and 62.6% during period 2. Hierarchical regression analysis reported reduction in delirium occurrence in the second period; this did not reach statistical significance, OR = 0.81 (95% CI 0.652-1.002); p = 0.052.CONCLUSION: No relationship was detected between whole blood thiamine and delirium occurrence on admission, at 24 and 48 h. It remains unclear whether routine intravenous thiamine supplementation during intensive care admission impacts delirium occurrence. Further prospective randomised clinical trials are needed.

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U2 - 10.1007/s11096-023-01690-x

DO - 10.1007/s11096-023-01690-x

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JO - International Journal of Clinical Pharmacy

JF - International Journal of Clinical Pharmacy

SN - 2210-7703

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ER -

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

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