Meta-Analysis
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 26, 2022; 10(12): 3773-3786
Published online Apr 26, 2022. doi: 10.12998/wjcc.v10.i12.3773
Melatonin intervention to prevent delirium in hospitalized patients: A meta-analysis
Wei You, Xiao-Yu Fan, Cheng Lei, Chen-Cong Nie, Yao Chen, Xue-Lian Wang
Wei You, Yao Chen, Xue-Lian Wang, Emergency Department Intensive Care Unit, Zigong Fourth People's Hospital, Zigong 643000, Sichuan Province, China
Xiao-Yu Fan, Department of General Surgery, Zigong Fourth People's Hospital, Zigong 643000, Sichuan Province, China
Cheng Lei, School of Public Health and Management, Chongqing Medical University, Chongqing 400000, Chongqing, China
Chen-Cong Nie, Department of Nursing, Zigong Fourth People's Hospital, Zigong 643000, Sichuan Province, China
Author contributions: You W and Fan XY contributed equally to this work; You W and Cheng L contributed to the design and provided the analysis; You W and Fan XY completed the data collection and provided statistical support; Nie CC, Chen Y, and Wang XL contributed to the manuscript preparation.
Supported by the Scientific Research Project of Sichuan Provincial Health Commission, No. 19PJ045.
Conflict-of-interest statement: The authors declare no conflicts of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed following the Creative Commons Attribution-Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xiao-Yu Fan, BSc, Chief Nurse, Department of General Surgery, Zigong Fourth People's Hospital, No. 2 Tanmulin Street, Ziliujing District, Zigong 643000, Sichuan Province, China. 453611550@qq.com
Received: July 5, 2021
Peer-review started: July 5, 2021
First decision: July 26, 2021
Revised: July 26, 2021
Accepted: April 3, 2022
Article in press: April 3, 2022
Published online: April 26, 2022
Abstract
BACKGROUND

Evaluation of the effectiveness of melatonin is necessary to prevent the development of delirium in hospitalized patients. Melatonin (N-acetyl-5-methoxytryptamine) is a hormone produced by the pineal gland of the brain from the amino acid tryptophan. Synthetic melatonin supplements have been used for various medical conditions, especially sleep-related diseases, and have proved to be successful.

AIM

To determine the effect of melatonin on the prevention of delirium in hospitalized patients.

METHODS

A literature search of the CNKI, Wanfang Database, VIP Database, China Biomedical Literature Database, PubMed, Embase, Cochrane Library, Web of Science, and other databases was conducted. The CNKI, Wanfang Database, VIP Database (VIP), and China Biomedical Literature Database were searched for Chinese studies, and PubMed, Embase, Cochrane Library, Web of Science and other databases were searched for international studies. It will be established in June 2021 in a randomized controlled trial (RCT) whether melatonin treatment for 6 mo prevents delirium in hospitalized patients. Literature screening, quality review, and data extraction were carried out using the Cochrane Manual 5.1.0 systematic evaluation method, and Stata 15.0 software and Review Manager 5.3 were used for meta-analysis and processing.

RESULTS

A total of 18 new RCT articles and 18 experimental subjects were identified. The results of the meta-analysis showed that following the occurrence of delirium, melatonin reduced the incidence of delirium in patients (RR = 0.69, 95%CI: 0.60-0.80), which is of significance, but heterogeneity was significant I2 = 62%. Subgroup analysis was performed to examine the source of heterogeneity, and it was found that different patient types were the source of heterogeneity; the research on subgroup analysis was of high quality and homogeneous. To determine the reliability and robustness of the research results, a sensitivity analysis was carried out. The results showed that after excluding individual studies one by one, the effect size was still within 95%CI, which strengthened the reliability of the original meta-analysis results. Melatonin has a significant preventive effect on delirium in hospitalized medical patients [RR = 0.60, 95%CI: 0.47-0.76), P < 0.001].

CONCLUSION

Melatonin can reduce the rate of delirium in medical patients, and the role of melatonin in reducing the incidence of delirium in surgical patients and critical care unit patients requires further study.

Keywords: Melatonin, Delirium, Prevention, Meta-analysis, Randomized controlled trial

Core Tip: Melatonin was shown to be effective in preventing delirium in hospitalized patients in this meta-analysis. Eighteen studies were reviewed involving 2137 patients and it was found that melatonin significantly reduced the incidence of delirium in hospitalized medical patients, but the effectiveness of melatonin in reducing the incidence of delirium in hospitalized surgical patients and intensive care unit patients requires further research.