Efficacy and moderators of prevention and treatment of delirium with melatonin receptor agonists: A systematic review and meta-analysis of randomized controlled trials
Delirium is a complex and heterogeneous condition that significantly affects patient outcome. This study aimed to conduct a systematic review and meta-analysis to investigate the effects of melatonin and melatonin receptor agonists (MRAs) on delirium prevention and treatment. Randomized controlled s...
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| Veröffentlicht in: | General hospital psychiatry 2023-11, Vol.85, p.71-79 |
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| container_title | General hospital psychiatry |
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| creator | Wada, Masataka Yasuda, Hideaki Nakajima, Shinichiro Etani, Takahide Miura, Akihiko Asada, Shintaro Yoshida, Kazunari Noda, Yoshihiro Takeuchi, Hiroyoshi |
| description | Delirium is a complex and heterogeneous condition that significantly affects patient outcome. This study aimed to conduct a systematic review and meta-analysis to investigate the effects of melatonin and melatonin receptor agonists (MRAs) on delirium prevention and treatment.
Randomized controlled studies, using MRAs as an intervention and placebo as a control were included. We conducted meta-analyses with random-effects model and trial sequential analysis.
A total of 33 studies involving 4850 participants were included. The meta-analysis revealed a significant preventive effect of MRAs on delirium (risk ratio = 0.65, p |
| doi_str_mv | 10.1016/j.genhosppsych.2023.08.011 |
| format | Article |
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Randomized controlled studies, using MRAs as an intervention and placebo as a control were included. We conducted meta-analyses with random-effects model and trial sequential analysis.
A total of 33 studies involving 4850 participants were included. The meta-analysis revealed a significant preventive effect of MRAs on delirium (risk ratio = 0.65, p < 0.01), while no significant therapeutic effect was observed. Additionally, MRAs were associated with a significant reduction in mortality rate (risk ratio = 0.90, p = 0.02) in delirium prevention studies. Furthermore, subgroup analyses revealed that assessment scales and the frequency of delirium detection may be significant moderators of the delirium-preventive efficacy of MRAs.
This study provides evidence of the potential effects of MRAs in preventing delirium and reducing mortality. Further research is required to elucidate the therapeutic potential of MRAs for delirium and identify specific patient populations that may benefit from this agent.
•MRAs showed a preventive effect on delirium.•Therapeutic effects on delirium severity remain inconclusive.•MRAs may be associated with lower mortality rates.•MRAs appeared less effective with sensitive or frequent delirium assessments.•More research is required to identify specific populations for delirium prevention.</description><identifier>ISSN: 0163-8343</identifier><identifier>EISSN: 1873-7714</identifier><identifier>DOI: 10.1016/j.genhosppsych.2023.08.011</identifier><identifier>PMID: 37826886</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Delirium ; Melatonin ; Melatonin receptor agonists ; Prevention ; Treatment</subject><ispartof>General hospital psychiatry, 2023-11, Vol.85, p.71-79</ispartof><rights>2023 Elsevier Inc.</rights><rights>Copyright © 2023 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c380t-f17f807791953b8d8ddcaf49e165d8a2c62145ed7bee0c0e8511132c6b9873583</citedby><cites>FETCH-LOGICAL-c380t-f17f807791953b8d8ddcaf49e165d8a2c62145ed7bee0c0e8511132c6b9873583</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.genhosppsych.2023.08.011$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37826886$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Wada, Masataka</creatorcontrib><creatorcontrib>Yasuda, Hideaki</creatorcontrib><creatorcontrib>Nakajima, Shinichiro</creatorcontrib><creatorcontrib>Etani, Takahide</creatorcontrib><creatorcontrib>Miura, Akihiko</creatorcontrib><creatorcontrib>Asada, Shintaro</creatorcontrib><creatorcontrib>Yoshida, Kazunari</creatorcontrib><creatorcontrib>Noda, Yoshihiro</creatorcontrib><creatorcontrib>Takeuchi, Hiroyoshi</creatorcontrib><title>Efficacy and moderators of prevention and treatment of delirium with melatonin receptor agonists: A systematic review and meta-analysis of randomized controlled trials</title><title>General hospital psychiatry</title><addtitle>Gen Hosp Psychiatry</addtitle><description>Delirium is a complex and heterogeneous condition that significantly affects patient outcome. This study aimed to conduct a systematic review and meta-analysis to investigate the effects of melatonin and melatonin receptor agonists (MRAs) on delirium prevention and treatment.
Randomized controlled studies, using MRAs as an intervention and placebo as a control were included. We conducted meta-analyses with random-effects model and trial sequential analysis.
A total of 33 studies involving 4850 participants were included. The meta-analysis revealed a significant preventive effect of MRAs on delirium (risk ratio = 0.65, p < 0.01), while no significant therapeutic effect was observed. Additionally, MRAs were associated with a significant reduction in mortality rate (risk ratio = 0.90, p = 0.02) in delirium prevention studies. Furthermore, subgroup analyses revealed that assessment scales and the frequency of delirium detection may be significant moderators of the delirium-preventive efficacy of MRAs.
This study provides evidence of the potential effects of MRAs in preventing delirium and reducing mortality. Further research is required to elucidate the therapeutic potential of MRAs for delirium and identify specific patient populations that may benefit from this agent.
•MRAs showed a preventive effect on delirium.•Therapeutic effects on delirium severity remain inconclusive.•MRAs may be associated with lower mortality rates.•MRAs appeared less effective with sensitive or frequent delirium assessments.•More research is required to identify specific populations for delirium prevention.</description><subject>Delirium</subject><subject>Melatonin</subject><subject>Melatonin receptor agonists</subject><subject>Prevention</subject><subject>Treatment</subject><issn>0163-8343</issn><issn>1873-7714</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><recordid>eNqNUU1PGzEUtKpWJdD-hcri1Msu_siuHW4IKK2E1Et7thz7LXG0thfbAS1_iL9Zh9CKY09PfjPzRp5B6JSSlhLan23bOwibmKcpz2bTMsJ4S2RLKH2HFlQK3ghBl-_RopJ5I_mSH6HjnLeEkI51_CM64kKyXsp-gZ6vh8EZbWasg8U-Wki6xJRxHPCU4AFCcTG8gCWBLr4u9piF0SW38_jRlQ32MFZVcAEnMDDVA1jf1Xcu-Rxf4DznAl4XZyr-4ODxYAZFNzrocc7uxS_VbfTuCSw2MZQUxxH2tk6P-RP6MNQBn1_nCfr97frX5ffm9ufNj8uL28ZwSUozUDFIIsSKrjq-llZaa_SwXAHtOys1Mz2jyw6sWAMQQ0B2lFJe1-tVza2T_AR9PdydUrzfQS7Ku2xgHHWAuMuKSSG4ZIz1lXp-oJoUc04wqCk5r9OsKFH7otRWvS1K7YtSRKpaVBV_efXZrT3Yf9K_zVTC1YEA9bc1s6SycRAMWFczLspG9z8-fwA7M7Ca</recordid><startdate>202311</startdate><enddate>202311</enddate><creator>Wada, Masataka</creator><creator>Yasuda, Hideaki</creator><creator>Nakajima, Shinichiro</creator><creator>Etani, Takahide</creator><creator>Miura, Akihiko</creator><creator>Asada, Shintaro</creator><creator>Yoshida, Kazunari</creator><creator>Noda, Yoshihiro</creator><creator>Takeuchi, Hiroyoshi</creator><general>Elsevier Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>202311</creationdate><title>Efficacy and moderators of prevention and treatment of delirium with melatonin receptor agonists: A systematic review and meta-analysis of randomized controlled trials</title><author>Wada, Masataka ; Yasuda, Hideaki ; Nakajima, Shinichiro ; Etani, Takahide ; Miura, Akihiko ; Asada, Shintaro ; Yoshida, Kazunari ; Noda, Yoshihiro ; Takeuchi, Hiroyoshi</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c380t-f17f807791953b8d8ddcaf49e165d8a2c62145ed7bee0c0e8511132c6b9873583</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Delirium</topic><topic>Melatonin</topic><topic>Melatonin receptor agonists</topic><topic>Prevention</topic><topic>Treatment</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Wada, Masataka</creatorcontrib><creatorcontrib>Yasuda, Hideaki</creatorcontrib><creatorcontrib>Nakajima, Shinichiro</creatorcontrib><creatorcontrib>Etani, Takahide</creatorcontrib><creatorcontrib>Miura, Akihiko</creatorcontrib><creatorcontrib>Asada, Shintaro</creatorcontrib><creatorcontrib>Yoshida, Kazunari</creatorcontrib><creatorcontrib>Noda, Yoshihiro</creatorcontrib><creatorcontrib>Takeuchi, Hiroyoshi</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>General hospital psychiatry</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Wada, Masataka</au><au>Yasuda, Hideaki</au><au>Nakajima, Shinichiro</au><au>Etani, Takahide</au><au>Miura, Akihiko</au><au>Asada, Shintaro</au><au>Yoshida, Kazunari</au><au>Noda, Yoshihiro</au><au>Takeuchi, Hiroyoshi</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Efficacy and moderators of prevention and treatment of delirium with melatonin receptor agonists: A systematic review and meta-analysis of randomized controlled trials</atitle><jtitle>General hospital psychiatry</jtitle><addtitle>Gen Hosp Psychiatry</addtitle><date>2023-11</date><risdate>2023</risdate><volume>85</volume><spage>71</spage><epage>79</epage><pages>71-79</pages><issn>0163-8343</issn><eissn>1873-7714</eissn><abstract>Delirium is a complex and heterogeneous condition that significantly affects patient outcome. This study aimed to conduct a systematic review and meta-analysis to investigate the effects of melatonin and melatonin receptor agonists (MRAs) on delirium prevention and treatment.
Randomized controlled studies, using MRAs as an intervention and placebo as a control were included. We conducted meta-analyses with random-effects model and trial sequential analysis.
A total of 33 studies involving 4850 participants were included. The meta-analysis revealed a significant preventive effect of MRAs on delirium (risk ratio = 0.65, p < 0.01), while no significant therapeutic effect was observed. Additionally, MRAs were associated with a significant reduction in mortality rate (risk ratio = 0.90, p = 0.02) in delirium prevention studies. Furthermore, subgroup analyses revealed that assessment scales and the frequency of delirium detection may be significant moderators of the delirium-preventive efficacy of MRAs.
This study provides evidence of the potential effects of MRAs in preventing delirium and reducing mortality. Further research is required to elucidate the therapeutic potential of MRAs for delirium and identify specific patient populations that may benefit from this agent.
•MRAs showed a preventive effect on delirium.•Therapeutic effects on delirium severity remain inconclusive.•MRAs may be associated with lower mortality rates.•MRAs appeared less effective with sensitive or frequent delirium assessments.•More research is required to identify specific populations for delirium prevention.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>37826886</pmid><doi>10.1016/j.genhosppsych.2023.08.011</doi><tpages>9</tpages></addata></record> |
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| source | Elsevier ScienceDirect Journals Complete |
| subjects | Delirium Melatonin Melatonin receptor agonists Prevention Treatment |
| title | Efficacy and moderators of prevention and treatment of delirium with melatonin receptor agonists: A systematic review and meta-analysis of randomized controlled trials |
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