Association Between Pre-ICU Selective Serotonin Reuptake Inhibitor Use and Delirium in Older Patients With Sepsis: A...

Area of Science:

• Geriatric Medicine
• Pharmacology
• Critical Care Medicine

Background:

• Inconsistent findings exist regarding the association between selective serotonin reuptuptake inhibitors (SSRIs) and delirium.
• Research is needed to clarify the effect of SSRIs on delirium in older patients with sepsis.

Purpose of the Study:

• To examine the association between pre-intensive care unit (ICU) SSRI use and delirium in older septic patients.
• Investigate the impact of SSRI exposure patterns, dosage, and specific drug types on delirium risk.

Main Methods:

• Utilized the Medical Information Mart for Intensive Care (MIMIC)-IV database for a cohort of 11,768 older septic patients.
• Employed multivariable logistic regression, stratified analyses for SSRI exposure, dosage, and drug type, and sensitivity analyses.

Main Results:

• Pre-ICU SSRI use was linked to lower odds of delirium (OR=0.759, P=0.002).
• Medium-dose SSRIs and pre-ICU citalopram use showed significant negative associations with delirium.
• Continuous SSRI use during ICU stay was not significantly associated with delirium.

Conclusions:

• Preadmission SSRI use, particularly citalopram or moderate doses, is associated with reduced delirium risk in older septic patients.
• Causality is unproven; routine SSRI initiation or discontinuation for delirium prevention is not recommended.
• Individualized patient care is essential, balancing treatment needs with potential SSRI withdrawal or side effects.