Incidence and risk factors of sepsis-associated delirium in the intensive care unit: a systematic review and meta-analysis.

OBJECTIVES

To investigate the incidence and risk factors of sepsis-associated delirium (SAD) in ICU patients, with the goal of providing evidence for risk stratification and guiding ICU delirium management.

METHODS

The study protocol was registered at PROSPERO on August 2, 2025 (CRD420251118228). A systematic search was conducted across PubMed, Embase, Web of Science, Cochrane Library, CNKI, Wanfang, VIP, and CBM databases. The methodological quality of the included studies was assessed using the Newcastle-Ottawa Scale (NOS). Meta-analysis was performed using Stata software (version 18.0).

RESULTS

Fifty-two studies comprising 89,789 ICU patients were included. The pooled incidence of SAD was 43% (95% CI: 39%-47%). Seventeen significant factors were identified across 32 studies that reported risk factors. High-evidence-strength factors (≥5 studies) included higher APACHE II score, SOFA score, advanced age, neuron-specific enolase, mechanical ventilation, lactate, S100β protein, and cerebrovascular disease. Mechanical ventilation showed the strongest association with SAD (OR = 2.623). Other factors also identified in fewer studies. In contrast, history of surgery, total bilirubin, and peripheral perfusion index appeared to be protective factors, although supported by limited evidence and should be interpreted with caution.

CONCLUSION

This systematic review and meta-analysis demonstrated incidence of SAD was high in ICU patients and identified multiple associated risk factors. These findings support early risk identification and targeted nursing interventions. Future research should focus on standardized diagnosis and nurse-led prevention strategies.

IMPLICATIONS FOR CLINICAL PRACTICE: Nurses should perform routine delirium screening in high-risk patients with sepsis and implement targeted interventions, including minimizing sedation, optimizing mechanical ventilation, and monitoring metabolic parameters such as blood glucose and lactate. Early mobilization and individualized care may be beneficial for patients at risk of SAD.