DELIRIUM EN EL PACIENTE HOSPITALIZADO: MECANISMOS NEUROINFLAMATORIOS, DISFUNCIÓN METABÓLICA Y PREVENCIÓN BASADA EN EVIDENCIA
Palabras clave:
Delirium, Pacientes hospitalizados, Inflamación, Microglía, Prevención primariaResumen
DOI: https://doi.org/10.46296/yc.v10i18.0869
Resumen
Introducción: el delirium es un síndrome neuropsiquiátrico agudo y fluctuante asociado con mayor mortalidad, estancia hospitalaria prolongada, institucionalización y deterioro cognitivo posterior. Su detección tardía sigue siendo una limitación clínica relevante en hospitalización médica. Objetivo: sintetizar críticamente la evidencia reciente sobre los mecanismos neuroinflamatorios, los precipitantes metabólicos y las estrategias de prevención y manejo del delirium en el paciente hospitalizado. Metodología: se realizó una revisión crítica de la literatura publicada entre 2016 y 2026 en PubMed/MEDLINE, Embase, Scopus y ScienceDirect. Se priorizaron revisiones sistemáticas, metaanálisis, cohortes y guías clínicas pertinentes a medicina interna, psiquiatría, neurología y cuidado crítico. Resultados: la evidencia respalda un modelo multifactorial en el que convergen inflamación sistémica, disfunción neurovascular, estrés neuroendocrino y vulnerabilidad cerebral previa. Entre los precipitantes modificables destacan hipoxemia, alteraciones electrolíticas, disglucemia, elevación del nitrógeno ureico y exposición a fármacos deliriógenos. No se identificó un biomarcador único con utilidad diagnóstica rutinaria, aunque proteína C reactiva, interleucina 6, cortisol, razón neutrófilo-linfocito y sTREM2 aportan información fisiopatológica y de estratificación. La estrategia preventiva con mejor soporte fue la intervención multicomponente no farmacológica. En contraste, los antipsicóticos no mostraron beneficio consistente para prevención y su uso terapéutico debe restringirse a cuadros con compromiso de seguridad. Conclusiones: el abordaje del delirium hospitalario debe ser sistemático, multidimensional y centrado en la corrección rápida de precipitantes, el tamizaje estructurado y los bundles preventivos no farmacológicos. La farmacoterapia tiene un papel adyuvante y selectivo.
Palabras claves: Delirium, Pacientes hospitalizados, Inflamación, Microglía, Prevención primaria.
Abstract
Introduction: delirium is an acute and fluctuating neuropsychiatric syndrome associated with higher mortality, prolonged hospitalization, institutionalization, and subsequent cognitive decline. Delayed recognition remains a major clinical limitation in medical wards. Objective: to critically synthesize recent evidence on neuroinflammatory mechanisms, metabolic precipitants, and evidence-based strategies for prevention and management of delirium in hospitalized patients. Methodology: a critical literature review was conducted using publications from 2016 to 2026 retrieved from PubMed/MEDLINE, Embase, Scopus, and ScienceDirect. Systematic reviews, meta-analyses, cohort studies, and clinical guidelines relevant to internal medicine, psychiatry, neurology, and critical care were prioritized. Results: current evidence supports a multifactorial model involving systemic inflammation, neurovascular dysfunction, neuroendocrine stress, and preexisting brain vulnerability. Modifiable precipitants include hypoxemia, electrolyte disturbances, dysglycemia, elevated blood urea nitrogen, and exposure to deliriogenic drugs. No single biomarker is suitable for routine diagnosis, although C-reactive protein, interleukin-6, cortisol, neutrophil-to-lymphocyte ratio, and cerebrospinal fluid sTREM2 provide physiopathological and stratification insights. Multicomponent nonpharmacological interventions remain the most strongly supported preventive strategy. By contrast, antipsychotics do not show consistent preventive benefit, and therapeutic use should be reserved for severe agitation or safety-threatening situations. Conclusions: hospital delirium requires a systematic and multidimensional approach focused on prompt correction of precipitants, structured screening, and nonpharmacological prevention bundles. Pharmacologic therapy should remain selective and adjunctive.
Keywords: Delirium, Inpatients, Inflammation, Microglia, Primary Prevention.
Información del manuscrito:
Fecha de recepción: 09 de febrero de 2026.
Fecha de aceptación: 15 de abril de 2026.
Fecha de publicación: 13 de mayo de 2026.
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Derechos de autor 2026 REVISTA CIENTÍFICA MULTIDISCIPLINARIA ARBITRADA YACHASUN - ISSN: 2697-3456
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