Abstract TP072: Use of the Delirium Burden Index to Assess Delirium-related Odds of Morality Among Patients with Acute Ischemic Stroke

Background: Delirium is associated with mortality for patients admitted with acute ischemic stroke (AIS). Delirium fluctuates, however, and patients with sustained delirium likely face increased risks. The Delirium Burden Index (DBI) has been proposed to measure overall delirium dose and may provide more nuanced assessment of patient condition. Methods: Data for patients admitted AIS between May 2016 and August 2025 were retrieved from the Registry of Neurological Endpoint Assessment among patients with Ischemic and Hemorrhagic Stroke (REINAH), including demographic, comorbidity, medication, and outcome data. Delirium was assessed every 12 hours for patients over 70 using the modified 4A’s Test and classified as delirium present on admission (onset within 48hrs of admission; DPOA) and hospital-acquired delirium (onset after 48hrs; HAD). Patient DBI was calculated as the squared number of positive assessments divided by the total number of assessments. Statistical differences were assessed using Wilcoxon rank-sum tests. Logistic regression models were fit to determine the association of DBI with inpatient morality as a numerical variable and when stratified by rounded quartiles. Odds ratios (ORs) and 95% confidence intervals (CIs) are reported. Results: Data were collected for 22849 AIS patients (median age: 69 [59-79]; 11536 (51.2%) Female; 3,428 (15.3%) Hispanic; 14924 (66.2%) White, 5995 (26.6%) Black, 1,288 (5.7%) Asian, 325 (1.4%) Other). In total, 6458 (28.6%) exhibited delirium with 4716 (20.9%) having delirium on admission (DOA) and 1742 (7.7%). Delirious patients had median DBI of 2.67 [0.57-7.11]. Patients with DOA had a significantly higher DBI than those with HAD (3.27 [0.88-8.00] vs 1.05 [0.25-4.45]; p<0.001) and, among delirious patients, those who expired had significantly higher DBI (4.5 [1.8-9.0] vs 2.3 [0.5-7.0]; p<0.001). In multivariable modelling of delirious patients, DBI showed a per-point adjusted Odds Ratio (aOR) of 1.02 [1.01-1.04] (p=0.002) and significantly higher odds of mortality were shown for all elevated DBI groups (1-3: 1.84 [1.44-2.35]; 3-7: 1.78 [1.41-2.26]; >7: 1.92 [1.52-2.43], vs <1) (Figure 1). Discussion: Assessing the overall dose of delirium can provide a nuanced perspective of patient status. The DBI provides a measure of delirium dose that is significantly associated with in-hospital morality, even when controlling for stroke severity and time of delirium onset.