Exploring the Association Between Intravenous Lorazepam and Mortality Among Older Hospitalized Patients With and Without Cognitive Impairment

Joseph H Flaherty; Riddhi R Patel; Anupama S Gangavati; Michael B Cannell

doi:10.7759/cureus.72121

Exploring the Association Between Intravenous Lorazepam and Mortality Among Older Hospitalized Patients With and Without Cognitive Impairment

Cureus. 2024 Oct 22;16(10):e72121. doi: 10.7759/cureus.72121. eCollection 2024 Oct.

Authors

Joseph H Flaherty^{1

2}, Riddhi R Patel^{3

4}, Anupama S Gangavati⁵, Michael B Cannell³

Affiliations

¹ Geriatrics, Envision Physician Services, Dallas, USA.
² Internal Medicine/Geriatrics, University of Texas Southwestern Medical School, Dallas, USA.
³ Epidemiology, Human Genetics and Environmental Sciences, UTHealth Houston School of Public Health, Dallas, USA.
⁴ Public Health, University of Texas, Houston, USA.
⁵ Internal Medicine, Geriatrics Division, UT Southwestern Medical School, Dallas, USA.

Abstract

Background In a previously published study about the effects of an inpatient geriatrics program on mortality among older patients with and without cognitive impairment, intravenous (IV) lorazepam was unexpectedly found to be one of the variables associated with mortality in the multivariate analysis. The purpose of this study was to further explore the association between IV lorazepam and mortality. Materials and Methods This was a secondary data analysis of a previously published retrospective study. The setting was a 500-bed community-based hospital, Level-1 Trauma Center, and Stroke Center (Dallas, Texas, United States). Participants were all patients aged 70+ admitted between January 1, 2017, and December 31, 2019. Logistic regression was used to evaluate the association between IV lorazepam (defined as receiving ≥1 dose) and mortality (death during hospitalization) among patients with cognitive impairment [defined as in the original study using a list of >30 IInternational Classification of Diseases, Tenth Edition (ICD-10)] and without cognitive impairment. Covariables included age, gender, case mix index, ICU stay, sepsis, palliative care, oral benzodiazepines, oral and IV antipsychotics, and oral and IV opioids. Logistic regression was used to calculate the adjusted odds ratio (aORs) and 95% confidence intervals (CI) of mortality. Results Of 20,541 patients, 6,197 (30.2%) had cognitive impairment of which 1430 (23.1%) received IV lorazepam, with a mortality rate of 16.9%. Of 14,344 patients without cognitive impairment, 1,468 (10.2%) received IV lorazepam, with a mortality rate of 32.0%. After controlling for covariables, aORs for mortality among those who received IV lorazepam was 3.37 (95% CI: 2.52-4.50) for patients with cognitive impairment and 7.72 (95% confidence interval (CI): 6.09-9.79) without cognitive impairment. Even when ICU and palliative care patients were excluded, aOR for mortality remained high for those with (4.09; 95% CI: 2.17-7.69) and without cognitive impairment, 18.82 (95% CI: 13.39-26.46). Conclusion Despite the limitations of this exploratory study, including a lack of data on the dosage and duration of IV lorazepam, further research is warranted to examine the possible association between IV lorazepam and increased mortality among older hospitalized patients, both with and without cognitive impairment.

Keywords: adverse drug events; benzodiazepines; cognitive impairment; delirium; dementia; geriatrics; hospitalized older patients; iv lorazepam; mortality.