Assessing the Risk of Delirium and Death in Sepsis Using the Braden Score: A Retrospective Study

Xinya Li; Yonglan Tang; Zihong Bai; Xin Liang; Xiaxuan Huang; Jianguang Chen; Hongtao Cheng; Jun Lyu; Yu Wang

doi:10.1111/jocn.17476

Assessing the Risk of Delirium and Death in Sepsis Using the Braden Score: A Retrospective Study

J Clin Nurs. 2024 Oct 11. doi: 10.1111/jocn.17476. Online ahead of print.

Authors

Xinya Li¹, Yonglan Tang¹, Zihong Bai², Xin Liang¹, Xiaxuan Huang³, Jianguang Chen², Hongtao Cheng¹, Jun Lyu^{4

5}, Yu Wang^{1

6

7}

Affiliations

¹ School of Nursing, Jinan University, Guangzhou, China.
² Department of Neurology, The First Affiliated Hospital of Jinan University, Guangzhou, China.
³ Department of Anesthesiology, The First Affiliated Hospital of Jinan University, Guangzhou, China.
⁴ Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China.
⁵ Key Laboratory of Regenerative Medicine of Ministry of Education, Guangzhou, China.
⁶ Community Health Service Center of Jinan University, Guangzhou, China.
⁷ Department of School Clinic, The First Affiliated Hospital of Jinan University, Guangzhou, China.

PMID: 39394637
DOI: 10.1111/jocn.17476

Abstract

Aims and objectives: To provide a viable tool for the early clinical identification of high-risk populations in patients with sepsis.

Background: Sepsis-associated delirium (SAD) has the potential to significantly impact the short- and long-term prognosis of patients. However, accurately predicting and effectively managing SAD remains a significant challenge.

Methods: This study employed a retrospective analysis of adult sepsis patients admitted to the intensive care unit (ICU) for the first time. Patients were divided into two groups based on their initial Braden score upon admission to the ICU: a high-risk group (≤ 15 points) and a low-risk group (> 15 points). The relationship between Braden score and delirium was assessed using logistic regression and restricted cubic splines, while restricted mean survival time was employed to analyse the relationship between Braden scores and patients' 90- and 180-day mortality.

Results: Of the 28,312 patients included in the study, those in the high-risk group exhibited a significantly elevated risk of delirium (44.8% vs. 29.7%) and higher 90-day (28.7% vs. 19.4%) and 180-day (33.2% vs. 24.1%) mortality rates (all p < 0.001). After adjusting for confounding variables, logistic regression demonstrated that the risk of delirium was 1.54 times higher in the high-risk group (95% CI = 1.45-1.64, p < 0.001). Following propensity score matching, the difference in survival was statistically significant at both time points, with the high-risk group having a reduced survival rate of 7.50 days (95% CI = -8.24, -6.75; p < 0.001) and 15.74 days (95% CI = -17.40, -14.08; p < 0.001) at 90 days and 180 days, respectively.

Conclusions: The Braden score is a simple and effective tool for the early identification of patients at increased risk of adverse outcomes in sepsis.

Design: Retrospective study.

Relevance to clinical practice: The Braden score can be employed by clinical nurses for the purpose of early identification of poor prognostic risk in patients with sepsis.

Reporting method: This study was conducted according to the Strengthening Research in Observational Studies in Epidemiology (STROBE) guidelines.

Patient or public contribution: Patients were involved in the sample of the study.

Keywords: Braden score; delirium; intensive care unit; mortality; sepsis.

Abstract

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