title: Systemic Corticosteroids and Transition to Delirium in Critically Ill Patients.
abstract: OBJECTIVE
  Corticosteroids are frequently used in critically ill patients. We investigated whether systemic corticosteroid use increases the probability of transitioning to delirium in a large population of mixed medical-surgical ICU patients.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  A 32-bed medical-surgical ICU at an academic medical center.
  
  
  METHODS
  Critically ill adults (n = 1,112), admitted to the ICU for more than 24 hours without a condition that could hamper delirium assessment.
  
  
  METHODS
  None.
  
  
  RESULTS
  Systemic corticosteroid exposure was measured daily and converted to prednisone equivalents (milligrams). Daily mental status was classified as coma, delirium, or an awake without delirium state. Transitions between states were analyzed using a first-order Markov multinomial logistic regression model with 11 different covariables, with the transition from an awake without delirium state to delirium as a primary interest. Among the 1,112 patients, corticosteroids were administered on 35% (3,483/9,867) of the ICU days at a median dose of 50 mg (interquartile range, 25-75 mg) prednisone equivalent. Administration of a corticosteroid, and any increase in the dose of the corticosteroid given on exposure days, was not significantly associated with the transition to delirium (adjusted odds ratio, 1.08; 95% CI, 0.89-1.32 and adjusted odds ratio, 1.00; 95% CI, 0.99-1.01, per 10 mg increase in prednisone equivalent).
  
  
  CONCLUSIONS
  In a large population of mixed medical-surgical ICU patients, systemic corticosteroid use was not associated with an increased probability of transitioning to delirium.
authors.affiliation: 1Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, The Netherlands. 2Institute of Psychology, Health, Medical, and Neuropsychology Unit, Faculty of Social Sciences, Leiden University, Leiden, The Netherlands. 3Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands. 4School of Pharmacy, Northeastern University, Boston, MA.
authors.forename: Annemiek E
authors.initials: AE
authors.lastname: Wolters
authors.forename: Dieuwke S
authors.initials: DS
authors.lastname: Veldhuijzen
authors.forename: Irene J
authors.initials: IJ
authors.lastname: Zaal
authors.forename: Linda M
authors.initials: LM
authors.lastname: Peelen
authors.forename: Diederik
authors.initials: D
authors.lastname: van Dijk
authors.forename: John W
authors.initials: JW
authors.lastname: Devlin
authors.forename: Arjen J C
authors.initials: AJ
authors.lastname: Slooter
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects*; D000328:Adult; D016638:Critical Illness; D003693:Delirium / Q000139:chemically induced*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales
chemical_list: D000305:Adrenal Cortex Hormones