Predisposing and Precipitating Factors of Delirium After Cardiac Surgery

Autor: Nils Theuerkauf, Sangar Stori, Christian Putensen, Ramy Malik, Julius Popp, Ingo Frommann, Mona Scheidemann, Ulf Guenther, Kathrin Brimmers
Rok vydání: 2013
Předmět:
Male
etiology [Delirium]
Time Factors
Comorbidity
law.invention
Risk Factors
law
statistics & numerical data [Length of Stay]
Delirium/etiology
Prospective Studies
Prospective cohort study
Cardiopulmonary Bypass
Age Factors
Intensive care unit
Systemic Inflammatory Response Syndrome
Cardiac surgery
Intensive Care Units
Cognition Disorders/complications
Length of Stay/statistics & numerical data
Female
medicine.symptom
Cohort study
complications [Cognition Disorders]
medicine.medical_specialty
behavioral disciplines and activities
Sensitivity and Specificity
Internal medicine
mental disorders
medicine
Humans
ddc:610
Cardiac Surgical Procedures
Aged
Psychiatric Status Rating Scales
Chi-Square Distribution
business.industry
complications [Systemic Inflammatory Response Syndrome]
Delirium
Length of Stay
medicine.disease
Confidence interval
nervous system diseases
Surgery
Logistic Models
ROC Curve
Systemic Inflammatory Response Syndrome/complications
Cognition Disorders
business
Chi-squared distribution
Zdroj: Annals of surgery 257(6), 1160-1167 (2013). doi:10.1097/SLA.0b013e318281b01c
Annals of Surgery, Vol. 257, No 6 (2013) pp. 1160-1167
ISSN: 0003-4932
DOI: 10.1097/sla.0b013e318281b01c
Popis: OBJECTIVE: To comprehensively assess pre-, intra-, and postoperative delirium risk factors as potential targets for intervention. BACKGROUND: Delirium after cardiac surgery is associated with longer intensive care unit (ICU) stay, and poorer functional and cognitive outcomes. Reports on delirium risk factors so far did not cover the full range of patients' presurgical conditions, intraoperative factors, and postoperative course. METHODS: After written informed consent, 221 consecutive patients ≥ 50 years scheduled for cardiac surgery were assessed for preoperative cognitive performance, and functional and physical status. Clinical and biochemical data were systematically recorded perioperatively. RESULTS: Of the 215 patients remaining for analysis, 31% developed delirium in the intensive care unit. Using logistic regression models, older age [73.3 (71.2-75.4) vs 68.5 (67.0-70.0); P = 0.016], higher Charlson's comorbidity index [3.0 (1.5-4.0) vs 2.0 (1.0-3.0) points; P = 0.009], lower Mini-Mental State Examination (MMSE) score (MMSE, [27 (23-29) vs 28 (27-30) points; P = 0.021], length of cardiopulmonary bypass (CPB) [CPB; 133 (112-163) vs 119 (99-143) min; P = 0.004], and systemic inflammatory response syndrome in the intensive care unit [25 (36.2%) vs 13 (8.9%); P = 0.001] were independently associated with delirium. Combining age, MMSE score, Charlson's comorbidity index, and length of CPB in a regression equation allowed for a prediction of postoperative delirium with a sensitivity of 71.19% and a specificity of 76.26% (receiver operating analysis, area under the curve: 0.791; 95% confidence interval: 0.727-0.845). CONCLUSIONS: Further research will evaluate if modification of these risk factors prevents delirium and improves outcomes.
Databáze: OpenAIRE
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