Melatonin intervention to prevent delirium in the intensive care units: a systematic review and meta-analysis of randomized controlled trials

Yushan Duan; Yuan Yang; Weihua Zhu; Linjun Wan; Gang Wang; Jinxi Yue; Qi Bao; Jianlin Shao; Xiaohong Wan

doi:10.3389/fendo.2023.1191830

Melatonin intervention to prevent delirium in the intensive care units: a systematic review and meta-analysis of randomized controlled trials

Front Endocrinol (Lausanne). 2023 Jul 26:14:1191830. doi: 10.3389/fendo.2023.1191830. eCollection 2023.

Authors

Yushan Duan¹, Yuan Yang², Weihua Zhu¹, Linjun Wan¹, Gang Wang¹, Jinxi Yue¹, Qi Bao¹, Jianlin Shao², Xiaohong Wan¹

Affiliations

¹ Department of Critical Care Medicine, The Second Affiliated Hospital, Kunming Medical University, Kunming, China.
² Department of Anesthesiology, The First Affiliated Hospital, Kunming Medical University, Kunming, China.

Abstract

Objective: To determine the preventive effect of melatonin on delirium in the intensive care units.

Methods: We conducted a systematic search of the PubMed, Cochrane Library, Science, Embase, and CNKI databases, with retrieval dates ranging from the databases' inception to September 2022. Controlled trials on melatonin and placebo for preventing delirium in the intensive care units were included. The meta-analysis was performed using Review Manager software (version 5.3) and Stata software (version 14.0).

Results: Six studies involving 2374 patients were included in the meta-analysis. The results of the meta-analysis showed that melatonin did not reduce the incidence of delirium in ICU patients (odds ratio [OR]: 0.71; 95% confidence interval [CI]: 0.46 to 1.12; p = 0.14). There was a strong hetero-geneity between the selected studies (I² = 74%). Subgroup analysis results showed that melatonin reduced the incidence of delirium in cardiovascular care unit (CCU) patients (OR: 0.52; 95% CI: 0.37 to 0.73; p=0.0001), but did not in general intensive care unit (GICU) patients (OR: 1.14; 95% CI: 0.86 to 1.50; p=0.35). In terms of the secondary outcomes, there were no significant differences in all-cause mortality (OR: 0.85; 95% CI: 0.66 to 1.09; p=0.20), length of ICU stay (mean difference [MD]: 0.33; 95% CI: -0.53 to 1.18; p=0.45), or length of hospital stay (MD: 0.51; 95% CI: -1.17 to 2.19; p=0.55).

Conclusion: Melatonin reduced the incidence of delirium in CCU patients, but did not significantly reduce the incidence of delirium in GICU patients.

Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42022367665.

Keywords: delirium; intensive care; melatonin; meta-analysis; randomized controlled trials.

Publication types

Meta-Analysis
Systematic Review
Research Support, Non-U.S. Gov't

MeSH terms

Delirium* / drug therapy
Delirium* / epidemiology
Delirium* / prevention & control
Humans
Intensive Care Units
Length of Stay
Melatonin* / therapeutic use
Randomized Controlled Trials as Topic

Substances

Melatonin

Grants and funding

This research was funded by The National Natural Science Foundation of China, grant number 81960250 and The Program of Science and Technology Agency of Yunnan Province, grant number 202101AB070114.