奎硫平预防住院成年患者谵妄的疗效和安全性：随机对照试验的系统回顾和荟萃分析

IF 3.7 2区医学 Q1 PSYCHIATRY

General hospital psychiatry Pub Date : 2025-10-21 DOI:10.1016/j.genhosppsych.2025.10.011

Raj Kiran Donthu , Sneha Mary Minz , Mamidipalli Sai Spoorthy , R. Dyuthy , A. Balaji , P.S. Sethu , Libnus B. Varghese , Shahul Ameen , Brijesh Sathian , Vikas Menon

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引用次数: 0

摘要

目的：我们旨在通过汇集平行组随机对照试验（rct）的证据，比较奎硫平与比较药物治疗在预防住院成年患者谵妄方面的有效性和安全性的总结估计。方法：检索MEDLINE、Embase、Scopus和临床试验注册库，检索时间从成立到2025年1月31日。我们的主要结局是组间谵妄的发生率。次要结局包括10天死亡率、住院时间、谵妄持续时间、谵妄严重程度、再入院率（疗效结局）和报告的不良反应（安全性结局）。结果：共纳入6项符合条件的rct（共N = 491）；其中5例纳入meta分析。预防谵谵症发生率的合并RR为0.61 (95% CI, 0.45-0.83；5个rct； I2 = 0;p = .001)，支持喹硫平（剂量范围12.5-75 mg/天）。谵妄持续时间的SMD为-1.21 (95% CI, -2.08至-0.35；3个rct； I2 = 86%; p = 0.006)，再次有利于喹硫平。其他结果组间无显著差异。四项研究没有喹硫平的不良反应，另外两项研究的不良反应最小。这些发现在敏感性分析中是稳健的。结论：低剂量喹硫平预防谵妄可能是一种安全有效的治疗选择。这些结论受到现有试验数量和规模较小的影响。

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Efficacy and safety of quetiapine prophylaxis for delirium in hospitalized adult patients: A systematic review and meta-analysis of randomized controlled trials

Objective

We aimed to compare summary estimates of efficacy and safety of quetiapine versus comparator treatments in preventing delirium among hospitalized adult patients by pooling evidence from parallel-group randomized controlled trials (RCTs).

Methods

We searched MEDLINE, Embase, Scopus, and clinical trial registers from inception till January 31st, 2025. Our primary outcome was between-group incidence of delirium. Secondary outcomes included 10-day mortality, duration of hospital stay, duration of delirium, severity of delirium, readmission rates (efficacy outcomes), and reported adverse effects (safety outcomes).

Results

Six eligible RCTs (pooled N = 491) were identified; of these, five were included in the meta-analysis. The pooled RR for preventing the incidence of delirium was 0.61 (95 % CI, 0.45–0.83;5 RCTs; I² = 0;p = .001), favoring quetiapine (dose range 12.5-75 mg/day). The SMD for duration of delirium was −1.21 (95 % CI, −2.08 to −0.35; 3 RCTs; I² = 86 %; p = .006), again favoring quetiapine. No significant between-group differences were noted on other outcomes. Adverse effects with quetiapine were absent in four studies and minimal in the other two. The findings were robust to sensitivity analyses.

Conclusion

Low-dose quetiapine prophylaxis may be a safe and effective treatment option for preventing delirium. These conclusions are tempered by the small number and size of existing trials.

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来源期刊

General hospital psychiatry 医学-精神病学

CiteScore

9.60

自引率

2.90%

发文量

125

审稿时长

20 days

期刊介绍： General Hospital Psychiatry explores the many linkages among psychiatry, medicine, and primary care. In emphasizing a biopsychosocial approach to illness and health, the journal provides a forum for professionals with clinical, academic, and research interests in psychiatry''s role in the mainstream of medicine.