THE S-SHAPED ASSOCIATION BETWEEN MNUTRIC SCORE AND DELIRIUM IN SEPTIC PATIENTS IN THE INTENSIVE CARE UNIT: A RETROSPECTIVE COHORT STUDY USING THE MIMIC-IV DATABASE

ABSTRACT: Background: The association between the modified Nutrition Risk in the Critically Ill (mNUTRIC) score and delirium in septic patients during their intensive care unit stay has not been studied. Hence, the objective of this study was to explore the correlation between the mNUTRIC score and the incidence of delirium events in these patients. Methods: We performed a retrospective analysis on critically ill patients diagnosed with sepsis using the MIMIC-IV 2.2 database. The mNUTRIC score was obtained within the initial 24 h of admission to the intensive care unit (ICU). The relationship between the mNUTRIC score and delirium occurring during ICU admission was examined using restricted cubic splines (RCS) and multivariable logistic regression. Additionally, propensity score matching, interaction analysis, and subgroup analysis were conducted to ensure the consistency of these study results. Results: A total of 8,438 participants were included, with mean age of 66.9 years, among them, 4,901 (58.1%) were male. The incidence of delirium was 24.6% (2,073/8,438). Compared to the low-risk group (mNUTRIC score <5), the incidence of delirium was markedly elevated in the high-risk group (mNUTRIC score ≥5), at 33.8% (95% CI, 32.1%-35.5%, P < 0.001). Specifically, the incidence of delirium in the low-risk group was 19.8% (95% CI, 18.4%-20.5%). In the multivariable regression model, after controlling for all covariates, for each unit increase in mNUTRIC score, the incidence of delirium increased by 19% (adjusted OR = 1.19, 95% CI, 1.10-1.28, P < 0.001). Our analysis revealed an S-shaped association between mNUTRIC score and delirium incidence, suggesting a complex relationship between nutritional risk and delirium, with the rate of increase in delirium incidence slowing at very high mNUTRIC scores. Compared to the low-risk group, the incidence of delirium was elevated in the high-risk group (adjusted OR = 1.42, 95% CI, 1.22-1.66, P < 0.001). Subgroup analysis and propensity score matching consistently indicated a notable correlation between mNUTRIC score and the incidence of ICU delirium. Conclusions: Among ICU patients with sepsis, higher mNUTRIC score are associated with an increased risk of delirium incidence.