Standardized Semi-Structured Psychosocial Evaluation before Stem Cell Transplantation Predicts Delirium Post-Transplant

Background Delirium affects many patients undergoing stem cell transplantation (SCT). Delirium is treatable but prevention is a better goal, making it desirable to identify patients at heightened risk for delirium. A standardized pre-transplant psychosocial assessment rating scale, the Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT), has been demonstrated to predict outcomes in solid organ transplant recipients, and non-adherence in SCT patients. In this study we evaluated the association of SIPAT score, and post-SCT incident delirium. Methods We retrospectively reviewed records of SCT recipients who had SIPAT evaluations prior to SCT, for indications of delirium in the 6 months post-transplant. We tested the association between SIPAT score and delirium by logistic regression, controlling for relevant co-variates such as transplant type (allogeneic vs. autologous). Results Of 85 patients (median age of 49 years, range 18-74), 56 (66%) were male, and 43 (50.5%) were autologous SCT recipients. The median pre-transplant SIPAT score was 8, range 0-40. There were 15 cases (17.6%) of delirium in the 6 months following transplant. In univariate analyses, transplant type and SIPAT score were significantly associated with incident delirium. Multivariate analysis confirmed the significant association of the SIPAT score and incident delirium (OR 1.090, p = 0.021). Conclusions Psychosocial risk as quantified by the SIPAT is associated with development of delirium in SCT recipients. This scale can therefore be integrated into medical risk models to anticipate which patients are at higher risk for delirium in their hospital course, enabling preventative measures tailored to the needs of the individual patient.