Propofol Use and Delirium in Patients Aged 80 Years and Over: A Retrospective Cohort Study of 9850 ICU Admissions

There is inconsistent evidence regarding the relationship between propofol and delirium, and this evidence is predominantly drawn from mixed-age adult cohorts. In this study, we examined the link between propofol exposure and the onset of delirium in patients aged 80 years and over-a rapidly growing and physiologically distinct intensive care unit (ICU) patient group.

We conducted a retrospective analysis of older adults (aged 80 years or over) included in the Medical Information Mart for Intensive Care (MIMIC-IV) database. We used multivariate logistic regression to examine the relationship between propofol use and the occurrence of delirium. To strengthen the reliability of our results, we performed sensitivity analyses using propensity score matching and inverse probability of treatment weighting, as well as subgroup analyses.

Among 9850 ICU patients aged > 80 years, delirium was observed in 3474 cases (35.3%). Propofol showed an independent association with delirium after covariate adjustment (OR 1.22, 95% CI 1.09-1.38). This significant link was confirmed by sensitivity analyses using inverse probability of treatment weighting (OR 1.22; 95% CI 1.09-1.38) and propensity score matching (OR 1.24; 95% CI 1.08-1.43). This finding remained consistent across most of the subgroup analyses.

These findings highlight the importance of careful sedation planning and increased monitoring when administering propofol to critically ill adults aged 80 years and over, who may be particularly susceptible to its neurocognitive effects.