Ictus-to-door time as a predictor of delirium in patients with acute ischemic stroke: a prospective cohort study

Abstract

Background: Delirium is a common and reversible neuropsychiatric complication that follows acute ischemic stroke (AIS). Despite the crescent understanding about your relation with AIS, the role of ictus-to-door time remains unclear in the generation of delirium. Objective: To analyze the correlation between the interval from ictus to admission in a stroke unit and risk of delirium. Methods: This prospective cohort study was conducted from May 2023 to March 2026 and included patients aged ≥ 18 years admitted to an intensive care unit with a diagnosis of AIS. The primary endpoint was the occurrence of delirium, which was systematically evaluated by the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) test. To evaluate the association between ictus-to-door and outcomes, a multivariable logistic regression was used. The model was controlled for age, thrombolytic therapy, baseline National Institutes of Health Stroke Scale (NIHSS) score, infection, baseline cognitive status, assessed by Short Informant Questionnaire on Cognitive Decline in the Eldery (Short IQ-CODE), and the ictus-to-door time. Adjusted Odds Ratios (aORs) and 95% Confidence Intervals (CIs) were calculated. Results: A total of 719 patients were included in the analysis. The mean age was 66.05 ± 12.75 years, 372 (51.7%) were male, and 612 (85.5%) were Afro-descendant. In-hospital infection occurred in 259 patients (36.0%), and 342 (47.8%) received thrombolytic therapy. The median NIHSS at admission and Short IQ-CODE were 7 (4.0-13.0) and 3 (3.00-3.25), respectively. Of the included patients, 169 (23.5%) developed delirium. The mean ictus-to-door time was 4.167 hours (3.0-8.1 hours). In the multivariable analysis, the ictus-to-door time was not associated with delirium (p=0.17), while age (aOR 1.03; 95% CI 1.01-1.05; p<0.01), NIHSS at admission (aOR 1.16; 95% CI 1.12-1.21; p<0.01), thrombolytic therapy (aOR 0.53; 95% CI 0.32-0.88; p=0.01), infection on site (aOR 5.75; 95% CI 3.70-8.94; p<0.01) and Short IQ-CODE (aOR 1.86; 95% CI 1.21-2.84; p<0.01) were independently associated with delirium. Conclusion: In our cohort, ictus-to-door time was not independently associated with delirium. These findings suggest that, beyond timely hospital admission, other clinical features such as infection plays a more important role in the devolpment of delirium in acure stroke setting.