Association Between Statin Use and Delirium in Critically Ill Patients with CKD: Retrospective Cohort Study from the MIMIC-IV Database

Background: Delirium is a common and severe issue for ICU patients with CKD, linked to higher rates of illness and death. Statins, which have anti-inflammatory and endothelial-stabilizing effects, may offer neuroprotection. Yet, the link between statin use and delirium risk in CKD patients in the ICU is not well understood. Methods: We conducted a retrospective cohort study using MIMIC-IV. Adult pts (≥18 y) with CKD admitted to ICU were included. Pts were grouped by in-hospital statin use. Primary outcome: ICU delirium incidence. 1:1 PSM was performed. Logistic regression assessed statin-delirium association. Cox models evaluated 30-/90-day mortality. Subgroup analyses included statin types and subgroups: age, sex, CHF, CAD, CeVD, COPD, DM, cancer, CKD stage, BZD/propofol use, CCI, SAPS, OASIS, SOFA Results: A total of 3218 pts met inclusion criteria (statin: 1778, non-statin: 1440). The statin group was older (76.1 vs. 73.0 y, P<0.001) with more males (66.6% vs. 59.4%, P<0.001). After PSM, 1066 matched pairs were analyzed. Statin use was linked to lower delirium risk (25.8% vs. 34.3%, P<0.001). Adjusted logistic regression confirmed protection (OR: 0.60, 95% CI: 0.49–0.74, P<0.001). Subgroup analysis showed consistent delirium reduction across most subgroups, with an interaction between statin use and BZ use (P=0.009). Statins also reduced 30-/90-day mortality in univariate & multivariable Cox models. No significant difference between lipophilic/hydrophilic statins in delirium prevention. Conclusion: Statin use is independently associated with reduced risk of delirium and improved short-term survival in ICU patients with CKD. These findings support further investigation of statins’ neuroprotective roles in this high-risk population. Funding: Government Support – Non-U.S.KM survival curves of 90-day mortality within the ICU for patients in statin-exposure and Non-statin.