Incidence and risk factors for delirium in critically ill patients with severe acute pancreatitis: a multicenter cohort study

doi:10.5847/wjem.j.1920-8642.2025.118

Abstract

Abstract:

BACKGROUND: Severe acute pancreatitis (SAP) is commonly associated with acute organ failure, but its effects on cerebral function within intensive care unit (ICU) patients remains inadequately researched. This study aims to determine the prevalence of delirium in critically ill patients diagnosed with SAP, and to identify risk factors associated with delirium in this patient population.

METHODS: This was a retrospective, multicenter study, which enrolled adult patients diagnosed with SAP who admitted intensive care unit (ICU) for at least 24 h. Patient assessment was conducted using the Richmond Agitation-Sedation Scale (RASS) and the Confusion Assessment Method for the ICU (CAM-ICU). The cumulative incidence of delirium was determined. Demographic, clinical data, and length of ICU stay were compared between patients with and without delirium. A logistic regression model was employed to identify potential risk factors for delirium.

RESULTS: A total of 1,814 patients were included from seven hospitals in Anhui province, China. Delirium was observed in 25.2% of patients. Logistic regression analysis identified APACHE II scores (odds ratio [OR]=3.37, 95% confidence interval [CI]: 1.09-10.43, P=0.04), physical restraint (OR=11.11, 95%CI: 4.35-28.39, P<0.05), invasive mechanical ventilation (IMV) (OR=2.44, 95%CI: 1.41-4.25, P=0.002), and ICU length of stay ≥ 7 days (OR=3.14, 95%CI: 2.27-4.36, P<0.05) as independent risk factors of delirium.

CONCLUSION: The present study revealed a substantial incidence of delirium in critically ill patients with SAP, associated with factors including APACHE II score, IMV, physical restraint, and prolonged ICU stays.

Key words: Severe acute pancreatitis, Delirium, Incidence, Intensive care unit, Risk factors

Wei Da, Mingyue Niu, Shu Zhou, Hong Wei, Limin Chen, Nan Wang, Xiaopei Cai, Chaozhi Ji, Juan Wang, Tiantian Zhu, Xiaobo Wang, Hong Zhang. Incidence and risk factors for delirium in critically ill patients with severe acute pancreatitis: a multicenter cohort study[J]. World Journal of Emergency Medicine, 2025, 16(6): 573-578.

Figures/Tables 4

Figure 1.

Table 1

Characteristics and outcomes of patients with SAP in the delirium and non-delirium groups (n=1,814)

Characteristics	Delirium (n=458)	Non-delirium (n=1,356)	P-value
Demographics variables
Age, years, median (IQR)	51 (41-70)	50 (37-57)	< 0.05
Age group, n (%)			< 0.05
≥60 years	202 (44.1%)	185 (13.6%)
<60 years	256 (55.9%)	1,171 (86.4%)
Gender, n (%)			0.11
Male	276 (60.3%)	759 (56.0%)
Female	182 (39.7%)	597 (44.0%)
Clinical etiologies of pancreatitis, n (%)			0.11
Biliary	124 (27.1%)	426 (31.4%)
Alcoholic	121 (26.4%)	339 (25.0%)
Hypertriglyceremic	16 (3.5%)	69 (5.1%)
Others	197 (43.0%)	522 (38.5%)
Body mass index, n (%)			0.30
<18.5	27 (5.9%)	69 (5.1%)
18.5-24	352 (76.9%)	1,088 (80.2%)
>24	79 (17.2%)	199 (14.7%)
Current/former smoker, n (%)	81 (17.7%)	269 (19.8%)	0.31
Alcohol use, n (%)	59 (12.9%)	201 (14.8%)	0.31
Types of hospital, n (%)			0.66
Non-teaching	109 (23.8%)	309 (22.8%)
Teaching	349 (76.2%)	1047 (77.2%)
Types of payer, n (%)			0.35
Medicare	349 (76.2%)	1,059 (78.1%)
Medicaid	30 (6.6%)	101 (7.4%)
Private insurance	39 (8.5%)	107 (7.9%)
Self-pay	27 (5.9%)	71 (5.2%)
No charge	6 (1.3%)	9 (0.6%)
Other	7 (1.5%)	9 (0.6%)
Invasive mechanical ventilation n (%)	281 (61.4%)	228 (16.8%)	<0.05
Laboratory values, median (IQR)
Hemoglobin, g/L	107 (103-111)	115 (109-119)	0.32
Albumin, g/L	30 (28-31)	32 (30-34)	0.17
Sodium, mmol/L	138 (137-139)	142 (139-143)	0.07
Potassium, mmol/L	3.6 (3.5-3.7)	3.8 (3.7-3.9)	0.12
Calcium, mmol/L	1.6 (1.5-1.7)	1.9 (1.8-1.9)	0.43
Chlorine, mmol/L	101 (99-102.25)	100 (98-101)	0.23
Serum amylase, U/L	685 (528-945)	513 (349-548)	0.76
APACHE II score, median (IQR)	16 (16-19)	12 (11-14)	<0.05
APACHE II score≥17, n (%)	188 (41.0%)	181 (13.3%)	<0.05
Comorbidities, n (%)
Diabetes	101 (22.1%)	245 (18.1%)	0.06
Hypertension	188 (41.0%)	507 (37.4%)	0.16
Heart failure	61 (13.3%)	144 (10.6%)	0.12
COPD	138 (30.1%)	353 (26.0%)	0.09
Kidney failure	149 (32.5%)	381 (28.1%)	0.07
Malignant tumors	51 (11.1%)	123 (9.1%)	0.19
Cerebral infarction	41 (9.0%)	89 (6.6%)	0.09
Cerebral hemorrhage	24 (5.2%)	47 (3.5%)	0.09
Epilepsy	15 (3.3%)	29 (2.1%)	0.17
Physical constraints, n (%)			<0.05
Required	256 (55.9%)	192 (14.2%)
Not required	202 (44.1%)	1,164 (85.8%)
LOS, d, n (%)			<0.05
<7	67 (14.6%)	741 (54.6%)
≥7	391 (85.4%)	615 (45.4%)
Mortality, n (%)	86 (18.8%)	205 (15.1%)	0.07

Table 1

Table 2

Table 3

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Complications	Delirium (n=458)	Non-delirium (n=1,356)	P-value
Respiratory failure	149 (32.5%)	381(28.1%)	0.07
Hepatic failure	73(15.9%)	169(12.5%)	0.06
Renal failure	69(15.1%)	148(10.9%)	0.02
Cardiac dysfunction	103(22.5%)	254(18.7%)	0.08
Gastrointestinal hemorrhage	79(17.2%)	191(14.1%)	0.10
ACS	77(16.8%)	175(12.9%)	0.04
Shock	114(24.9%)	291(21.5%)	0.13
Sepsis	292(63.8%)	801(59.1%)	0.08

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