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. 2024 Dec 18;28(1):413.
doi: 10.1186/s13054-024-05204-7.

Sex specific differences in short-term mortality after ICU-delirium

Nikolaus Schreiber  1 , Michael Eichlseder  2 , Simon Orlob  1   3 , Christoph Klivinyi  1 , Philipp Zoidl  2 , Alexander Pichler  2 , Michael Eichinger  2 , Simon Fandler-Höfler  4 , Laura Scholz  5 , Jekaterina Baumgartner  5 , Michael Schörghuber  1 , Philipp Eller  6
Affiliations

Sex specific differences in short-term mortality after ICU-delirium

Nikolaus Schreiber et al. Crit Care. .

Abstract

Introduction: Delirium is a frequent complication in critically ill patients and is associated with adverse outcomes such as long-term cognitive impairment and increased mortality. It is unknown whether there are sex-related differences in intensive care unit (ICU) delirium and associated outcomes. We aimed to assess sex-specific differences in short-term mortality following ICU-delirium.

Methods: We conducted a retrospective cohort study using the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database. Adult ICU patients who were diagnosed with delirium using the Confusion Assessment Method for the ICU (CAM-ICU) were included. The primary outcome was 30-day mortality following delirium onset. To control for baseline differences in demographics, illness severity, and comorbidities, we applied 1:1 propensity score matching. Cox proportional hazards regression models were used to evaluate the association between sex and mortality.

Results: A total of 8950 ICU patients with delirium were analyzed, of whom 42.6% were women. In univariable analysis, women had higher crude mortality (26.0% vs. 23.4%; HR 1.16, 95% CI 1.071-1.267, p < 0.001). After propensity score matching, the cohort included 3811 women and 3811 men. In adjusted analysis, risk for thirty-day mortality remained higher in women (HR 1.16, 95% CI 1.064-1.273, p < 0.001).

Conclusion: Our study suggests that women with ICU-delirium have a significantly higher risk of short-term mortality than men. Acknowledging the limitations inherent to observational studies with potential for residual confounding, further research is needed to understand the biological and clinical factors driving this disparity and to inform sex-specific interventions for ICU-delirium.

Keywords: ICU-delirium; Mortality; Personalized ICU-care; Sex differences.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The MIMIC database was approved by the institutional review boards of the Beth Israel Deaconess Medical Center (2001-P-001699/14) and the Massachusetts Institute of Technology (No. 0403000206), which waived the requirement for individual patient consent because the datasets contained deidentified information. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Kaplan–Meier survival curve by sex. 30-day survival probability after delirium onset compared between men (in blue) and women (in orange). 95%-Confidence Intervals are depicted as shaded areas. Log-Rank Test p-value: 0.0004
See this image and copyright information in PMC

References

    1. Stollings JL, Kotfis K, Chanques G, Pun BT, Pandharipande PP, Ely EW. Delirium in critical illness: clinical manifestations, outcomes, and management. Intensive Care Med. 2021;47(10):1089–103. - PMC - PubMed
    1. Kotfis K, van Diem-Zaal I, Williams Roberson S, Sietnicki M, van den Boogaard M, Shehabi Y, et al. The future of intensive care: delirium should no longer be an issue. Crit Care Lond Engl. 2022;26(1):200. - PMC - PubMed
    1. Smit L, Slooter AJC, Devlin JW, Trogrlic Z, Hunfeld NGM, Osse RJ, et al. Efficacy of haloperidol to decrease the burden of delirium in adult critically ill patients: the EuRIDICE randomized clinical trial. Crit Care Lond Engl. 2023;27(1):413. - PMC - PubMed
    1. Carayannopoulos KL, Alshamsi F, Chaudhuri D, Spatafora L, Piticaru J, Campbell K, et al. Antipsychotics in the treatment of delirium in critically ill patients: a systematic review and meta-analysis of randomized controlled trials. Crit Care Med. 2024;52(7):1087–96. - PubMed
    1. Fisher T, Hill N, Kalakoutas A, Lahlou A, Rathod K, Proudfoot A, et al. Sex differences in treatments and outcomes of patients with cardiogenic shock: a systematic review and epidemiological meta-analysis. Crit Care Lond Engl. 2024;28(1):192. - PMC - PubMed

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