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. 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. 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). 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.

中文翻译：

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ICU 谵妄后短期死亡率的性别特异性差异


谵妄是危重患者的常见并发症，与长期认知障碍和死亡率增加等不良后果有关。目前尚不清楚重症监护病房 （ICU） 谵妄和相关结局是否存在性别相关差异。我们旨在评估 ICU 谵妄后短期死亡率的性别特异性差异。我们使用 Medical Information Mart for Intensive Care-IV （MIMIC-IV） 数据库进行了一项回顾性队列研究。纳入使用 ICU 混淆评估方法 （CAM-ICU） 诊断为谵妄的成年 ICU 患者。主要结局是谵妄发作后 30 天的死亡率。为了控制人口统计学、疾病严重程度和合并症的基线差异，我们应用了 1：1 倾向评分匹配。使用 Cox 比例风险回归模型评估性别与死亡率之间的关联。共分析 8950 例 ICU 谵妄患者，其中 42.6% 为女性。在单变量分析中，女性的粗死亡率更高（26.0% 对 23.4%;HR 1.16,95% CI 1.071–1.267，p < 0.001）。倾向得分匹配后，该队列包括 3811 名女性和 3811 名男性。在调整后的分析中，女性 30 天死亡的风险仍然较高 （HR 1.16,95% CI 1.064–1.273，p < 0.001）。我们的研究表明，患有 ICU 谵妄的女性短期死亡风险明显高于男性。认识到观察性研究固有的局限性，可能存在残留混杂，需要进一步的研究来了解导致这种差异的生物学和临床因素，并为 ICU 谵妄的性别特异性干预措施提供信息。