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Association of thiamine supplementation with 30-day mortality among ICU patients with sepsis-associated delirium
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  • Published: 23 March 2026

Association of thiamine supplementation with 30-day mortality among ICU patients with sepsis-associated delirium

  • Haibo Wang1 na1,
  • Yaotang Wang2 na1,
  • Caixia Li3 &
  • …
  • Ruimin Hu4 

Scientific Reports , Article number:  (2026) Cite this article

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We are providing an unedited version of this manuscript to give early access to its findings. Before final publication, the manuscript will undergo further editing. Please note there may be errors present which affect the content, and all legal disclaimers apply.

Subjects

  • Diseases
  • Health care
  • Medical research
  • Risk factors

Abstract

Sepsis-associated delirium (SAD) is a common and severe complication in critically ill patients and is associated with increased mortality. Thiamine is an essential coenzyme in mitochondrial energy metabolism, and deficiency is frequent in critical illness. However, the association between thiamine supplementation and survival in ICU patients with SAD remains unclear. We conducted a retrospective cohort study using the MIMIC-IV (v3.1) database. Adult ICU patients meeting Sepsis-3 criteria and diagnosed with delirium during ICU stay were included. Patients were categorized according to thiamine supplementation during ICU admission. Propensity score–based methods, including matching, adjustment, and multiple weighting approaches, were applied to balance baseline covariates. The primary outcome was 30-day all-cause mortality. We performed survival, subgroup, and sensitivity analyses. We also conducted duration–response and dose–response analyses to evaluate whether thiamine treatment duration and average daily dose were associated with prognosis. In the MIMIC-IV cohort, 332 ICU patients with sepsis-associated delirium received thiamine supplementation, while 956 did not. Thirty-day mortality was significantly lower in the thiamine group compared with the non-thiamine group (P < 0.001). Thiamine use was associated with improved survival in crude analysis and remained significantly associated with lower 30-day mortality after multivariable adjustment (HR, 0.51; 95% CI, 0.33–0.79; P = 0.002). Consistent associations were observed across propensity score analyses, including propensity score–adjusted analysis (HR, 0.59; 95% CI, 0.40–0.85; P = 0.005), propensity score matching (HR, 0.59; 95% CI, 0.39–0.90; P = 0.015), inverse probability of treatment weighting (HR, 0.54; 95% CI, 0.38–0.77; P = 0.002), standardized mortality ratio weighting (HR, 0.68; 95% CI, 0.47–0.98; P = 0.052), pairwise algorithmic weighting (HR, 0.63; 95% CI, 0.40–0.97; P = 0.016), and overlap weight (HR, 0.60; 95% CI, 0.36–1.02; P = 0.008). Weighted subgroup analyses demonstrated consistent associations across clinical strata, with a significant interaction by illness severity indicating a survival benefit of thiamine among patients with SOFA scores < 4. Duration-response and dose-response analyses suggested greater benefit with longer treatment courses and lower daily dosing. Thiamine supplementation was associated with reduced 30-day mortality in ICU patients with sepsis-associated delirium, with an observed interaction in the SOFA score subgroup, where a SOFA score below 4 was associated with survival benefit. Duration–response and dose–response analyses suggested greater benefit with longer treatment courses and lower daily dosing.

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Data availability

The datasets analyzed during this investigation are publicly accessible in the MIMIC-IV repository (v3.1) at: https://physionet.org/content/mimiciv/3.1/.

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Acknowledgements

We would like to thank the Massachusetts Institute of Technology and the Beth Israel Deaconess Medical Center for the MIMIC-IV database. We are grateful for the guidance on database extraction provided by Dr. Yang Qilin from the Second Affiliated Hospital of Guangzhou Medical University.

Funding

This study was not supported by any targeted funding from public sector agencies, commercial entities, or nonprofit organizations.

Author information

Author notes

  1. Haibo Wang and Yaotang Co-First Authors.

Authors and Affiliations

  1. Department of Critical Care Medicine, Inner Mongolia People’s Hospital, Affiliated to Baotou Medical College, Hohhot, Inner Mongolia Autonomous Region, China

    Haibo Wang

  2. Department of Critical Care Medicine, The First People’s Hospital of Xiaogan City, Xiaogan City, 432000, Hubei Province, China

    Yaotang Wang

  3. Department of Critical Care Medicine, People’s Hospital of Inner Mongolia Auton omous Region, Hohhot, 010020, Inner Mongolia, China

    Caixia Li

  4. Department of Pulmonary and Critical Care Medicine and Key Laboratory of Nati onal Health Commission for the Diagnosis & Treatment of COPD, Inner Mongolia P eople’s Hospital, Hohhot, Inner Mongolia Autonomous Region, China

    Ruimin Hu

Authors
  1. Haibo Wang
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  2. Yaotang Wang
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  3. Caixia Li
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  4. Ruimin Hu
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Contributions

Haibo Wang 1† , Yaotang Wang 2† , Caixia Li 3* , and Ruimin Hu 4Co-First Authors (†):Haibo Wang and Yaotang Wang contributed equally to core research execution (study design, data acquisition, analysis, and manuscript drafting).Corresponding Author (*):Caixia Li oversaw project coordination, critical revision of the manuscript, and acts as the primary contact for communication.Ruimin Hu finished technical assistance, resources provision and data curation.

Corresponding author

Correspondence to Caixia Li.

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The authors declare no competing interests.

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MIMIC-IV is a de-identified, publicly available database approved by the institutional review boards of Beth Israel Deaconess Medical Center and the Massachusetts Institute of Technology. Given the de-identified nature of the data, the requirement for informed consent was waived. Co-first author Yaotang Wang obtained access to the MIMIC-IV database after completing the required training on the National Institutes of Health (NIH) platform, including the courses “Study data or Specimens only” and “Conflict of interest” (certification numbers: 59979404 and 59979406).

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Cite this article

Wang, H., Wang, Y., Li, C. et al. Association of thiamine supplementation with 30-day mortality among ICU patients with sepsis-associated delirium. Sci Rep (2026). https://doi.org/10.1038/s41598-026-44384-w

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  • Received: 09 October 2025

  • Accepted: 11 March 2026

  • Published: 23 March 2026

  • DOI: https://doi.org/10.1038/s41598-026-44384-w

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Keywords

  • Sepsis-associated delirium
  • Thiamine
  • Critical care
  • Mortality
  • Propensity score matching
  • MIMIC-IV database
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