Evidence map›Paper›PMID 41787440›Full record

ArticleCritical care (London, England)2026

Association between acute kidney injury and delirium in critically ill patients: a retrospective cohort study using two independent databases.

Christian Porschen, Christian Strauß, Sean M Bagshaw, John A Kellum, Sven G Meuth, Paul Brauckmann, Ngoc-Anh Thi Nguyen, Michael Fujarski, Keyvan Mahjoory, Carla Barbara Schwienhorst and 1 more

Abstract read
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In one paragraph

Article in Critical care (London, England), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Christian PorschenDepartment of Anesthesiology, Intensive Care, and Pain Medicine, University Hospital Muenster, University of Muenster, 48149, Muenster, Germany.
Christian StraußDepartment of Anesthesiology, Intensive Care, and Pain Medicine, University Hospital Muenster, University of Muenster, 48149, Muenster, Germany.
Sean M BagshawDepartment of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta and Alberta Health Services, Edmonton, AB, Canada.
John A KellumCenter for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
Sven G MeuthDepartment of Neurology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany.
Paul BrauckmannInstitute for Medical Informatics, University of Muenster, Muenster, Germany.
Ngoc-Anh Thi NguyenInstitute of Translational Psychiatry, University of Muenster, Muenster, Germany.
Michael FujarskiInstitute for Medical Informatics, University of Muenster, Muenster, Germany.
Keyvan MahjooryInstitute of Translational Psychiatry, University of Muenster, Muenster, Germany.
Carla Barbara SchwienhorstDepartment of Anesthesiology, Intensive Care, and Pain Medicine, University Hospital Muenster, University of Muenster, 48149, Muenster, Germany.
Alexander ZarbockDepartment of Anesthesiology, Intensive Care, and Pain Medicine, University Hospital Muenster, University of Muenster, 48149, Muenster, Germany. zarbock@uni-muenster.de.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAcute kidney injury (AKI) and delirium are common complications in critically ill patients, both associated with adverse outcomes. Evidence suggests AKI may induce neuroinflammation and impair clearance of neurotoxic metabolites, but the clinical relationship between AKI and delirium remains incompletely characterized. We hypothesized that AKI increases the risk of delirium in a biological gradient.

methodsWe conducted a retrospective cohort study using two independent databases: MIMIC-IV (n = 15,219 patients) and a local institutional database (Reality) from University Hospital Münster (n = 3,461 patients). Adult ICU patients with length of stay > 12 h and validated delirium monitoring using the Confusion Assessment Method for the ICU (CAM-ICU) were included, with a positive assessment defining delirium presence. Patients with neurological/neurosurgical primary diagnoses or pre-existing cognitive impairment, as well as patient with delirium onset before AKI were excluded. AKI was classified according to KDIGO criteria. We employed landmark analysis at 24 h post-ICU admission where AKI-status was recorded as the exposure variable. Subsequent delirium was recorded as follow-up during the ICU stay. Propensity score matching, and a Fine-Gray Model were added to assess the time-based association between AKI and subsequent delirium, independently of illness severity.

resultsAt the 24-hour landmark, AKI was present in 58.6% (MIMIC-IV) and 55.6% (Reality) of patients. Rates of subsequent delirium were significantly higher in patients with AKI compared to those without: 25.6% versus 15.7% in MIMIC-IV (OR 1.84, CI 1.68–2.04, p < 0.001) and 12.1% versus 6.7% in Reality (OR 1.95, CI 1.44–2.64, p < 0.001). After adjustment for confounders, AKI remained associated with delirium (adjusted-odds ratio [OR] 1.16, 95% CI 1.10–1.23 in MIMIC-IV; OR 1.20, 95% CI 1.01–1.41 in Reality). A biological gradient was observed, with delirium rates increasing progressively across AKI stages. In MIMIC-IV, adjusted-OR increased from 1.42 for Stage 1 to 4.11 for Stage 3 AKI (trend OR 1.55 per stage, p < 0.001). The Reality cohort showed similar patterns (Stage 1 OR 1.01 and Stage 3 OR 1.92, trend OR 1.25 per stage, p < 0.01). Propensity score matching confirmed these findings.

conclusionAcute kidney injury was associated with a higher risk of subsequent delirium in critically ill patients, with a graded association across AKI severity stages. Prospective studies are needed to determine whether interventions targeting AKI prevention or treatment can also reduce delirium burden.

Indexed as

Acute Kidney InjuryDeliriumAgedCohort StudiesCritical IllnessFemaleHumansIntensive Care UnitsLength of StayMaleMiddle AgedPropensity ScoreRetrospective StudiesRisk Factors

Identifiers

PMID41787440
PMCPMC13063765

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.