<i>Background:</i> Cerebrospinal fluid (CSF) analysis has great potential to advance understanding of delirium pathophysiology. <i>Methods:</i> A systematic literature review of CSF studies of DSM or ICD delirium was performed. <i>Results:</i> In 8 studies of 235 patients, delirium was associated with: elevated serotonin metabolites, interleukin-8, cortisol, lactate and protein, and reduced somatostatin, β-endorphin and neuron-specific enolase. Elevated acetylcholinesterase predicted poor outcome after delirium and higher dopamine metabolites were associated with psychotic features. <i>Conclusions:</i> No clear conclusions emerged, but the current literature suggests multiple areas for further investigation with more detailed studies.