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Abstract
Objectives Delirium is a form of brain dysfunction with high incidence and is associated with many negative outcomes in the intensive care unit. However, few studies have been large enough to reliably examine the associations between body mass index (BMI) and delirium, especially in critically ill patients. The objective of this study was to investigate the association between BMI and delirium incidence in critically ill patients.
Design A retrospective cohort study.
Setting Data were collected from the Medical Information Mart for Intensive Care-IV V2.0 Database consisting of critically ill participants between 2008 and 2019 at the Beth Israel Deaconess Medical Center in Boston.
Participants A total of 20 193 patients with BMI and delirium records were enrolled in this study and were divided into six groups.
Primary outcome measure Delirium incidence.
Results Generalised linear models and restricted cubic spline analysis were used to estimate the associations between BMI and delirium incidence. A total of 30.81% of the patients (6222 of 20 193) developed delirium in the total cohort. Compared with those in the healthy weight group, the patients in the different groups (underweight, overweight, obesity grade 1, obesity grade 2, obesity grade 3) had different relative risks (RRs): RR=1.10, 95% CI=1.02 to 1.19, p=0.011; RR=0.93, 95% CI=0.88 to 0.97, p=0.003; RR=0.88, 95% CI=0.83 to 0.94, p<0.001; RR=0.94, 95% CI=0.86 to 1.03, p=0.193; RR=1.14, 95% CI=1.03 to 1.25, p=0.010, respectively. For patients with or without adjustment variables, there was an obvious U-shaped relationship between BMI as a continuous variable and delirium incidence.
Conclusion BMI was associated with the incidence of delirium. Our results suggested that a BMI higher or lower than obesity grade 1 rather than the healthy weight in critically ill patients increases the risk of delirium incidence.
- Adult intensive & critical care
- PSYCHIATRY
- Obesity
- Delirium & cognitive disorders
Data availability statement
Data are available in a public, open access repository. The datasets analysed during the current study are available in the MIMIC-IV repository (https://physionet.org/content/mimiciv/2.0/).
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
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Data availability statement
Data are available in a public, open access repository. The datasets analysed during the current study are available in the MIMIC-IV repository (https://physionet.org/content/mimiciv/2.0/).
Supplementary materials
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Footnotes
JF and XZ contributed equally.
Contributors All authors contributed to the manuscript. SC initiated the study and was responsible for the overall content as the guarantor. The manuscript was drafted by JF and was refined by XZ and GZ. The data were extracted and statistical advice was provided by CW, QF and XG. YJ and SC contributed to the interpretation of the results and critical revision of the manuscript. They have all read, refined and approved the final manuscript.
Funding This study was supported by the National Natural Science Foundation of China (grant number 82273556), the Key Project in the Science & Technology Program of Sichuan Province (grant numbers 2022YFS0233, 2022YFS0225), the Project of ‘0 to 1’ of Sichuan University (grant number 2022SCUH0033), Med-X Center for Informatics Funding Project (YGJC004), and the 1·3·5 Project for Disciplines of Excellence Clinical Research Incubation Project, West China Hospital of Sichuan University (grant numbers ZYJC21060, 2020HXFH048).
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.
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