Dynamic Mean Arterial Pressure Trajectories and Risk of Delirium in Patients with Sepsis: A Retrospective Cohort Study

Abstract Background Delirium is a serious complication in septic ICU patients, often related to cerebral hypoperfusion and hemodynamic instability. However, the effect of dynamic blood pressure patterns on delirium risk remains unclear. Therefore, we sought to investigate the association between mean arterial pressure (MAP) trajectories during early ICU stay and the subsequent development of delirium in patients with sepsis. Methods We retrospectively analyzed 1,055 adults with sepsis from the Medical Information Mart for Intensive Care IV(MIMIC-IV)database. MAP during the first 24 hours after ICU admission was recorded every 2 hours. Group-based trajectory modeling identified distinct MAP patterns. The primary outcome was delirium during ICU stay. Associations between MAP trajectories and delirium risk were evaluated using multivariable Fine–Gray and Cox models, considering 7-day mortality as a competing event. Results Seven distinct MAP trajectories were identified, showing substantial interindividual variability in early hemodynamic patterns. Classes 4 and 6, characterized by rising and sharply declining MAP, exhibited the highest delirium risk, with cumulative incidences of about 75% and 65% by 120 hours. Using Class 5 (persistently low MAP) as the reference, multivariable analyses showed hazard ratios of 2.456–2.856 for Class 4 and 2.114–2.682 for Class 6 (all p < 0.05). Classes 1 and 5 had the lowest risk, while Classes 2, 3, and 7 showed intermediate risk. Subgroup analyses confirmed consistent associations across demographics and interventions. Conclusions Early MAP trajectories are strongly associated with delirium risk in sepsis. Acute hemodynamic deterioration, especially rising or sharply declining MAP, identifies high-risk patients.