Incidence and predictors of delirium on the intensive care unit in patients with acute kidney injury, insight from a retrospective registry

Abstract

Acute kidney injury (AKI) and delirium are common complications on the intensive care unit (ICU). Few is known about the association of AKI and delirium, as well as about incidence and predictors of delirium in patients with AKI. In this retrospective study, all patients with AKI, as defined by the KDIGO (kidney disease improving global outcome) guideline, treated for more than 24 h on the ICU in an university hospital in 2019 were included and analyzed. Delirium was defined by a NuDesc (Nursing Delirium screening scale) ≥ 2, which is evaluated three times a day in every patient on our ICU as part of daily routine. A total of 383/919 (41.7%) patients developed an AKI during the ICU stay. Delirium was detected in 230/383 (60.1%) patients with AKI. Independent predictors of delirium were: age, psychiatric disease, alcohol abuse, mechanical ventilation, severe shock, and AKI stage II/III (all p < 0.05). The primary cause of illness had no influence on the onset of delirium. Among patients with AKI, the duration of the ICU stay correlated with higher stages of AKI and the presence of delirium (stage I/no delirium: median 1.9 (interquartile range (25th–75th) 1.3–2.9) days; stage II/III/no delirium: 2.6 (1.6–5.5) days; stage I/delirium: 4.1 (2.5–14.3) days; stage II/III/delirium: 6.8 (3.5–11.9) days; all p < 0.01). Delirium, defined as NuDesc ≥ 2 is frequent in patients with AKI on an ICU and independently predicted by higher stages of AKI.

Acute kidney injury-associated delirium: a review of clinical and pathophysiological mechanisms

“…Specifically, a 1.5-fold increased risk of delirium was observed with KDIGO stage 2 (OR 1.55; 95% CI, 1.07–2.26) and a 2.5-fold increased risk of delirium with stage 3 (OR 2.56; 95% CI, 1.57–4.16) AKI, while KDIGO stage 1 was not significantly associated with delirium (OR 1.13, 95% CI 0.91–1.41) [ 2 ]. Concordant data were reported in a retrospective study that analyzed the medical records of 919 medical ICU patients of whom 41.6% developed AKI and found a higher incidence of delirium with KDIGO stage 2 (66.7%) and stage 3 (66.9%) AKI compared with KDIGO stage 1 (53.6%) [ 1 ]. Another prospective cohort study of 304 patients aged 60 or older found elevated creatinine level of > 2 mg/dL (OR 2.1, 95% CI 1.1–4.0) as one of 4 admission risk factors for delirium along with dementia, receipt of benzodiazepines before ICU admissions, and low arterial pH [ 24 ].…”

“…Delirium occurs in approximately 60% of patients with acute kidney injury (AKI) [ 1 ]. Substantial clinical evidence suggests a direct pathological role for AKI in delirium.…”

“…common clinical manifestation of AKI-associated acute brain injury is delirium, which presents as an acute or fluctuating impairment in attention, executive, function, or short-term memory [3,[14][15][16][17][18]. In the short term, delirium is well known to be strongly associated with increased mortality, prolonged hospitalization, and need for intensive medical interventions [1], while persistent cognitive decline is a feared long-term sequela [19].…”

A nomogram model for assessing predictors and prognosis of postoperative delirium in patients receiving acute type A aortic dissection surgery

“…The predictors that were found to be significantly related to the development of POD in our patient cohort included acute kidney injury (AKI). Previous studies [ 30 ] have indicated that higher AKI stages are a potential risk factor for POD development. Multiple pathophysiological mechanisms explain the enhanced delirium risk in patients with advanced AKI stages.…”