Abstract
Background
Delirium is a common complication in intensive care unit (ICU) patients, and it can
significantly increase the length of hospital stay and cost. Dexamethasone is widely
used in various inflammatory diseases and must be used with caution in critically
ill patients. Previous studies have shown that the effect of corticosteroid use on
the development of delirium in critically ill patients is still controversial, and
there is inconclusive conclusion about the effect of dexamethasone on delirium in
such patients. Therefore, this study aimed to confirm the effect of dexamethasone
use and the dose on the incidence of delirium and patient prognosis in critically
ill patients through a large cohort study.
Methods
A retrospective cohort study was conducted using data extracted from the Medical Information
Mart for Intensive Care III database, which is a large and freely available database
of all 46,476 patients who visited Beth Israel Deaconess Medical Center in Boston,
Massachusetts, USA and were admitted to the ICU between 2001 and 2012. The primary
outcome was the development of delirium, using multivariate logistic regression analysis
to reveal the relationship between dexamethasone and delirium. Secondary endpoints
were in-hospital mortality, ICU mortality, total length of stay, and length of ICU
stay, and the relationship between dexamethasone and prognosis was assessed with Cox
proportional hazards models. Propensity score matching with 1:1 grouping was used
to eliminate the effect of confounders on both cohorts. The locally weighted scatter
plot smoothing technique was used to investigate the dose correlation between dexamethasone
and outcomes, subgroup analysis was used to account for heterogeneity, and different
correction models and propensity matching analysis were used to eliminate potential
confounders.
Results
Finally, 38,509 patients were included, and 2204 (5.7%) used dexamethasone. No significant
statistical difference was observed in basic demographic information after propensity
score matching between the two study groups. A significantly higher incidence of delirium
(5.0% versus 3.4%, P < 0.001), increased in-hospital mortality (14.9% versus 10.3%, P < 0.001), ICU mortality (9.0% versus 7.5%, P = 0.008), and longer length of stay and ICU stay were observed in patients taking
dexamethasone compared with those not taking dexamethasone. Multivariate logistic
and Cox regression analyses confirmed that dexamethasone was significantly associated
with delirium (adjusted odds ratio = 1.48, 95% confidence interval [CI] = 1.09-2.00,
P = 0.012), in-hospital mortality (adjusted hazard ratio = 1.19, 95% CI = 1.02-1.40,
P = 0.032), and ICU mortality (adjusted hazard ratio = 1.62, 95% CI = 1.22-2.15, P = 0.001). Compared with critically ill patients using high-dose dexamethasone, the
risk of delirium was lower in the dose less than the 10 mg group, and patients using
10-14 mg may be associated with a lower risk of in-hospital death and the least ICU
mortality, length of hospital stay, and ICU stay.
Conclusions
This study demonstrated that the use of dexamethasone in critically ill patients exacerbated
the occurrence of delirium while increasing the risk of in-hospital death, ICU death,
and length of hospital stay, with a lower risk of delirium and a shorter total length
of hospital stay with low-dose dexamethasone than with larger doses.
Keywords
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Article info
Publication history
Published online: February 24, 2021
Accepted:
January 22,
2021
Received in revised form:
January 1,
2021
Received:
November 5,
2020
Identification
Copyright
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