Fang Yipeng, Tang Xiaohong, Gao Ying, Xie Hui, Shen Yuehao, Peng Min, Liu Jie, Zhang Yunfei, Cui Yan, Xie Keliang
Department of Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin, China.
Firth Clinical College, Xinxiang Medical University, Xinxiang, China.
CNS Neurosci Ther. 2025 Jan;31(1):e70201. doi: 10.1111/cns.70201.
This study investigates the association between blood urea nitrogen (BUN) levels and the risk of delirium in critically ill elderly patients without kidney disease.
A retrospective analysis was conducted using data from the MIMIC-IV database. The relationship between BUN and delirium risk was illustrated through the restricted cubic spline (RCS) method. Patients were stratified by BUN levels and examined for delirium incidence using logistic regression, subgroup analysis, and sensitivity analysis. Mendelian randomization (MR) was employed to explore potential causal relationships.
The maximum BUN level exhibited the strongest non-linear positive association with the odds of delirium. Compared to the Q1 group, both the Q3 (23-31 mg/dL) and Q4 (> 31 mg/dL) groups consistently showed increased odds of developing delirium. Subgroup analysis identified a significant interaction between BUN and midazolam, with the association only evident in patients not exposed to midazolam. After adjusting for baseline characteristics, the odds ratio for delirium was found to range from 1.35 to 1.39 in those with BUN levels exceeding 23 mg/dL. However, the MR analysis did not reveal any significant causal relationship (all p > 0.05).
In conclusion, elevated BUN may be a risk factor for delirium in critically ill elderly patients without renal dysfunction, with this potential link possibly modulated by midazolam exposure.
本研究调查无肾脏疾病的重症老年患者血尿素氮（BUN）水平与谵妄风险之间的关联。
使用多中心重症医学信息库（MIMIC-IV）数据库的数据进行回顾性分析。通过限制性立方样条（RCS）方法阐述BUN与谵妄风险之间的关系。根据BUN水平对患者进行分层，并使用逻辑回归、亚组分析和敏感性分析检查谵妄发生率。采用孟德尔随机化（MR）方法探索潜在的因果关系。
BUN最高水平与谵妄几率呈现出最强的非线性正相关。与第一四分位数（Q1）组相比，第三四分位数（Q3，23 - 31mg/dL）组和第四四分位数（Q4，>31mg/dL）组发生谵妄的几率持续增加。亚组分析确定了BUN与咪达唑仑之间存在显著交互作用，这种关联仅在未使用咪达唑仑的患者中明显。在调整基线特征后，发现BUN水平超过23mg/dL的患者发生谵妄的比值比在1.35至1.39之间。然而，MR分析未发现任何显著的因果关系（所有p>0.05）。
总之，在无肾功能障碍的重症老年患者中，BUN升高可能是谵妄的一个危险因素，这种潜在联系可能受咪达唑仑暴露的调节。
