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Published on: January 16, 2019
Association Between Pre-ICU Selective Serotonin Reuptake Inhibitor Use and Delirium in Older Patients With Sepsis: A
Background:
Existing literature presents inconsistent findings regarding the association between selective serotonin reuptake inhibitors (SSRIs) and delirium, necessitating refined research clarifying the effect of SSRIs on delirium in older septic patients.
Objective:
To examine the association between pre‑intensive care unit (ICU) SSRI use and delirium in older septic patients.
Methods:
This study utilized data from the Medical Information Mart for Intensive Care (MIMIC)‑IV database. Multivariable logistic regression models were employed to quantify target correlations, with stratified assessments covering 3 SSRI exposure patterns (no use, pre‑ICU only, and continuous use), graded SSRI dosage, and specific drug type in relation to delirium. Subgroup analyses were performed to assess the link across different patient characteristics. Sensitivity analyses based on drug half‑lives were also conducted.
Results:
A total of 11 768 older septic patients were included, of whom 754 used SSRIs before ICU admission. In the fully adjusted model, pre‑ICU SSRI use was linked to lower odds of delirium (odds ratio [OR] = 0.759, 95% confidence interval [CI] 0.637-0.901, P = 0.002). Continuous SSRI use during ICU stay showed no significant association (P = 0.493). Among dosage groups, only medium‑dose SSRIs were negatively associated with delirium (OR = 0.789, 95% CI 0.639-0.972, P = 0.027). Pre‑ICU citalopram use was significantly associated with reduced odds of delirium (OR = 0.660, 95% CI 0.495-0.874, P = 0.004). No significant interaction was identified in subgroup analyses (P for interaction > 0.05). Sensitivity analyses yielded results consistent with the primary findings.
Conclusion And Relevance:
Among MIMIC-IV aged sepsis patients, pre-ICU SSRIs (notably citalopram or moderate doses) link to lower delirium risk, with no correlation for in-ICU sustained medication. Preadmission SSRI data facilitate delirium risk evaluation; causality is unproven, and routine initiation, maintenance, or discontinuation of SSRIs solely for delirium prevention is not recommended. Individualized care balancing treatment needs, withdrawal and side effects awaits prospective verification.
