Melatonin intervention to prevent delirium in hospitalized patients: A meta-analysis

摘要

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 formeta-analysis and processing.RESULTSA total of 18 new RCT articles and 18 experimental subjects were identified. The results of themeta-analysis showed that following the occurrence of delirium, melatonin reduced the incidenceof delirium in patients (RR = 0.69, 95%CI: 0.60-0.80), which is of significance, but heterogeneitywas 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 onsubgroup analysis was of high quality and homogeneous. To determine the reliability androbustness of the research results, a sensitivity analysis was carried out. The results showed thatafter excluding individual studies one by one, the effect size was still within 95%CI, whichstrengthened the reliability of the original meta-analysis results. Melatonin has a significantpreventive effect on delirium in hospitalized medical patients [RR = 0.60, 95%CI: 0.47-0.76), P <0.001].CONCLUSIONMelatonin can reduce the rate of delirium in medical patients, and the role of melatonin inreducing the incidence of delirium in surgical patients and critical care unit patients requiresfurther study.