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Wang W, Yao W, Tang W, Li Y, Lv Q, Ding W. Association between preoperative albumin levels and postoperative delirium in geriatric hip fracture patients. Front Med (Lausanne) 2024; 11:1344904. [PMID: 38420358 PMCID: PMC10899384 DOI: 10.3389/fmed.2024.1344904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 01/24/2024] [Indexed: 03/02/2024] Open
Abstract
Objective This study aims to examine the association between preoperative serum albumin levels and postoperative delirium (POD) in geriatric patients who have undergone hip fracture surgery, with the goal of offering novel insights for clinical interventions targeting POD. Methods A retrospective analysis was conducted on the medical records of patients who underwent hip fracture surgery in a tertiary medical institution from January 2013 to November 2023. The patients were classified based on hypoalbuminemia (defined as a serum albumin level < 35 g/L) and clinical threshold. Multivariable logistic regression and propensity score matching analysis (PSM) were employed to calculate the adjusted odds ratios (OR) and 95% confidence intervals (95% CI) for POD to eliminate potential confounding factors. Additionally, subgroup analysis was performed to explore the interaction effect. Results The retrospective cohort study included 1,440 patients, with an incidence of POD found to be 19.1%. In a multivariable logistic regression analysis, patients with hypoalbuminemia had an adjusted OR of 2.99 (95%CI: 2.14-4.18) compared to those with normal albumin levels (≥ 35 g/L). Furthermore, a significant trend was observed across different severity categories, including mild hypoalbuminemia (34.9-30.0 g/L; adjusted OR = 2.71, 95%CI: 1.84-3.99), moderate hypoalbuminemia (29.9-25.0 g/L, adjusted OR = 3.44, 95%CI: 1.88-6.28), and severe hypoalbuminemia (<25.0 g/L; adjusted OR = 3.97, 95%CI: 1.78-8.86), with a trend value of p <0.001. Similar results were observed in the PSM analysis. Additionally, treating preoperative serum albumin level as a continuous variable, the risk of POD increased by 11% (95% CI, 1.08-1.15) with each 1 g/L decrease in preoperative serum albumin level. Conclusion Low preoperative levels of albumin are strongly associated with POD in geriatric patients with hip fractures, and a significant dose-response relationship exists between them.
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Affiliation(s)
- Wei Wang
- Department of Orthopedics, Dandong Central Hospital, China Medical University, Dandong, China
| | - Wei Yao
- Department of Orthopedics, Dandong Central Hospital, China Medical University, Dandong, China
| | - Wanyun Tang
- Department of Orthopedics, Dandong Central Hospital, China Medical University, Dandong, China
| | - Yuhao Li
- Department of Orthopedics, Dandong Central Hospital, China Medical University, Dandong, China
| | - Qiaomei Lv
- Department of Oncology, Dandong Central Hospital, China Medical University, Dandong, China
| | - Wenbo Ding
- Department of Orthopedics, Dandong Central Hospital, China Medical University, Dandong, China
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Callan KT, Donnelly M, Lung B, McLellan M, DiGiovanni R, McMaster W, Yang S, Stitzlein R. Risk factors for postoperative delirium in orthopaedic hip surgery patients: a database review. BMC Musculoskelet Disord 2024; 25:71. [PMID: 38233831 PMCID: PMC10792907 DOI: 10.1186/s12891-024-07174-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 01/05/2024] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Postoperative delirium is a common problem affecting admitted patients that decreases patient satisfaction and increases the cost and complexity of care. The purpose of this study was to use the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database to compare rates and risk factors of postoperative delirium for total hip arthroplasty (THA) and hemiarthroplasty patients indicated for osteoarthritis or proximal femur fracture. METHODS The 2021 NSQIP database was queried for patients using Current Procedural Terminology (CPT) codes for THA and hemiarthroplasty and ICD-10 codes for osteoarthritis or proximal femur fracture. Demographic, past medical history, preoperative labs, and functional status data were recorded. Procedural data were also collected. Finally, postoperative outcomes and complications were reviewed. RESULTS Overall, 16% of patients had postoperative delirium. Delirium patients were older on average (82.4 years vs. 80.7 years, p < 0.001), had a lower BMI (19.5 vs. 24.8, p < 0.001), were more likely to have a history of dementia (54.6% vs. 13.6%, p < 0.001), were less likely to have an independent functional status (p < 0.001) or live alone (p < 0.001), and were more likely to have sustained a recent fall (p < 0.001). Delirium patients were more likely to be hyponatremic or hypernatremic (p = 0.002), anemic (p < 0.001), and severely dehydrated (p < 0.001), among other lab abnormalities. Delirium patients were also more likely to experience additional postoperative complications, including pneumonia, pulmonary embolism, urinary tract infection, stroke, cardiac arrest, sepsis, and unplanned reoperation and readmission after discharge (all p < 0.05). CONCLUSIONS In this study, factors associated with postoperative delirium in patients undergoing hemiarthroplasty and THA were identified, including older age, lower BMI, certain medical conditions, decreased functional status, certain lab abnormalities, and postoperative complications. These findings can be used by clinicians to better inform care and to determine when orthopaedic joint replacement patients may be at an increased risk for postoperative delirium.
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Affiliation(s)
- Kylie T Callan
- University of California Irvine School of Medicine, Irvine, CA, USA.
| | - Megan Donnelly
- New York University Langone Medical Center, New York, NY, USA
| | - Brandon Lung
- University of California Irvine Health, Orange, CA, USA
| | | | | | | | - Steven Yang
- University of California Irvine Health, Orange, CA, USA
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Piccirillo A, Perri F, Vittori A, Ionna F, Sabbatino F, Ottaiano A, Cascella M. Evaluating Nutritional Risk Factors for Delirium in Intensive-Care-Unit Patients: Present Insights and Prospects for Future Research. Clin Pract 2023; 13:1577-1592. [PMID: 38131687 PMCID: PMC10742123 DOI: 10.3390/clinpract13060138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 11/30/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023] Open
Abstract
Malnutrition, hypercatabolism, and metabolic changes are well-established risk factors for delirium in critically ill patients. Although the exact mechanisms are not fully understood, there is mounting evidence suggesting that malnutrition can cause a variety of changes that contribute to delirium, such as electrolyte imbalances, immune dysfunction, and alterations in drug metabolism. Therefore, a comprehensive metabolic and malnutrition assessment, along with appropriate nutritional support, may help to prevent or ameliorate malnutrition, reduce hypercatabolism, and improve overall physiological function, ultimately lowering the risk of delirium. For this aim, bioelectrical impedance analysis can represent a valuable strategy. Further research into the underlying mechanisms and nutritional risk factors for delirium is crucial to developing more effective prevention strategies. Understanding these processes will allow clinicians to personalize treatment plans for individual patients, leading to improved outcomes and quality of life in the intensive-care-unit survivors.
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Affiliation(s)
- Arianna Piccirillo
- Otolaryngology and Maxillo-Facial Surgery Unit, Istituto Nazionale Tumori—IRCCS Fondazione G. Pascale, 80131 Naples, Italy
| | - Francesco Perri
- Medical and Experimental Head and Neck Oncology Unit, Istituto Nazionale Tumori—IRCCS Fondazione G. Pascale, 80131 Naples, Italy
| | - Alessandro Vittori
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù IRCCS, Piazza S. Onofrio 4, 00165 Rome, Italy
| | - Franco Ionna
- Otolaryngology and Maxillo-Facial Surgery Unit, Istituto Nazionale Tumori—IRCCS Fondazione G. Pascale, 80131 Naples, Italy
| | | | - Alessandro Ottaiano
- SSD Innovative Therapies for Abdominal Metastases, Abdominal Oncology, Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, 80131 Naples, Italy;
| | - Marco Cascella
- Unit of Anesthesiology, Intensive Care Medicine, and Pain Medicine, Department of Medicine, Surgery, and Dentistry, University of Salerno, Via Salvador Allende, 43, 84081 Baronissi, Italy
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Hu W, Song Z, Shang H, Wang J, Hao Y. Inflammatory and nutritional markers predict the risk of post-operative delirium in elderly patients following total hip arthroplasty. Front Nutr 2023; 10:1158851. [PMID: 38024358 PMCID: PMC10651730 DOI: 10.3389/fnut.2023.1158851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 10/13/2023] [Indexed: 12/01/2023] Open
Abstract
Objectives This study intended to explore whether albumin-associated inflammatory and nutritional markers could predict post-operative delirium (POD) in older patients after total hip arthroplasty (THA). In addition, we established a nomogram model for POD prediction. Methods Totally, 254 elderly cases who received THA were included. Clinical and laboratory data of these patients were retrospectively collected. Albumin-associated inflammatory and nutritional markers included neutrophil-to-albumin ratio (NAR), CRP-to-albumin ratio (CAR), prognostic nutritional index (PNI), and systemic inflammation score (SIS). The LASSO, univariate and multivariate logistic regression analyses were utilized to screen risk factors. A nomogram model was developed according to the results of multivariate regression analyses. Results Among 254 patients, 49 cases had POD with an incidence of 19.3%. LASSO regression and multivariate logistic analyses suggested that preoperative NAR, preoperative PNI, preoperative SIS, and age >75 years were risk factors for POD. A nomogram model was developed according to the results of multivariate logistic analyses. The calibration curve suggested that the predicted probability of this nomogram model was in good line with the actual probability. The DCA showed that this nomogram model had net benefits for the prediction of POD for elderly patients following THA. Conclusion Albumin-associated inflammatory and nutritional markers including NAR, PNI, and SIS could predict POD in elderly patients following THA.
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Affiliation(s)
- Wenhao Hu
- Department of Orthopedic Surgery, The Affiliated Huaian No.1 People’s Hospital of Nanjing Medical University, Huai’an, Jiangsu, China
| | - Ziyi Song
- Department of Orthopedic Surgery, The Affiliated Huaian No.1 People’s Hospital of Nanjing Medical University, Huai’an, Jiangsu, China
| | - Houlai Shang
- Department of Orthopedic Surgery, The Affiliated Huaian No.1 People’s Hospital of Nanjing Medical University, Huai’an, Jiangsu, China
| | - Jingcheng Wang
- Department of Orthopedics, Subei People’s Hospital of Jiangsu Province, Yangzhou, Jiangsu, China
| | - Yuedong Hao
- Department of Orthopedic Surgery, The Affiliated Huaian No.1 People’s Hospital of Nanjing Medical University, Huai’an, Jiangsu, China
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Xu Z, Yao S, Jiang Z, Hu L, Huang Z, Zeng Q, Liu X. Development and validation of a prediction model for postoperative intensive care unit admission in patients with non-cardiac surgery. Heart Lung 2023; 62:207-214. [PMID: 37567008 DOI: 10.1016/j.hrtlng.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 08/01/2023] [Accepted: 08/01/2023] [Indexed: 08/13/2023]
Abstract
BACKGROUND Accurately forecasting patients admitted to the intensive care units (ICUs) after surgery may improve clinical outcomes and guide the allocation of expensive and limited ICU resources. However, studies on predicting postoperative ICU admission in non-cardiac surgery have been limited. OBJECTIVE To develop and validate a prediction model combining pre- and intraoperative variables to predict ICU admission after non-cardiac surgery. METHODS This study is based on data from the Vital Signs DataBase (VitalDB) database. Predictors were selected using the least absolute shrinkage and selection operator regression method and logistic regression to develop a nomogram and an online web calculator. The model was internally verified by 1000-Bootstrap resampling. Performance of model was evaluated using area under the receiver operating characteristic curve (AUC), calibration curve and Brier score. The Youden's index was used to find the optimal nomogram's probability threshold. Clinical utility was assessed by decision curve analysis. RESULTS This study included 5216 non-cardiac surgery patients; of these, 812 (15.6%) required postoperative ICU admission. Potential predictors included age, ASA classification, surgical department, emergency surgery, preoperative albumin level, preoperative urea nitrogen level, intraoperative crystalloid, intraoperative transfusion, intraoperative catheterization, and surgical time. A nomogram was constructed with an AUC of 0.917 (95% CI: 0.907-0.926) and a Brier score of 0.077. The Bootstrap-adjusted AUC was 0.914; the adjusted Brier score was 0.078. The calibration curve showed good agreement between predicted and actual probabilities; and the decision curve indicated clinical usefulness. Finally, we established an online web calculator for clinical application (https://xuzhikun.shinyapps.io/postopICUadmission1/). CONCLUSION We developed and internally validated an easy-to-use nomogram for predicting ICU admission after non-cardiac surgery.
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Affiliation(s)
- Zhikun Xu
- Department of Critical Care Medicine, Shenzhen People's Hospital, First Affiliated Hospital of Southern University of Science and Technology, The Second Affiliated Hospital of Jinan University, Shenzhen 518020, China
| | - Shihua Yao
- Division of Cardiovascular Surgery, Cardiac and Vascular Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen 518053, China
| | - Zhongji Jiang
- Department of Biology, School of Medicine, Shenzhen Center, Cancer Hospital Chinese Academy of Medical Sciences, Southern University of Science and Technology, Shenzhen, Guangdong 518055, China
| | - Linhui Hu
- Department of Critical Care Medicine, Maoming People's Hospital, The Affiliated Maoming Hospital of Southern Medical University, Maoming 525000, China
| | - Zijun Huang
- Department of Anesthesiology, Maoming People's Hospital, The Affiliated Maoming Hospital of Southern Medical University, Maoming 525000, China
| | - Quanjun Zeng
- Department of Anesthesiology, University of Chinese Academy of Sciences Shenzhen Hospital, Shenzhen 518107, China
| | - Xueyan Liu
- Department of Critical Care Medicine, Shenzhen People's Hospital, First Affiliated Hospital of Southern University of Science and Technology, The Second Affiliated Hospital of Jinan University, Shenzhen 518020, China.
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Zhao Y, Quon A, Luke K, Tivis LJ. Impact of nursing interventions on discharge disposition in patients with postoperative delirium. Nursing 2023; 53:51-57. [PMID: 37856302 DOI: 10.1097/01.nurse.0000978892.66327.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
PURPOSE To identify patient characteristics and perioperative factors associated with non-home patient discharges and the impact of current delirium nursing interventions on discharge disposition, especially non-home dispositions. METHODS A retrospective pilot chart review was conducted using electronic health records from five networked hospitals in the Mountain West region of the US. The sample comprised 75 randomly selected patients aged 65 or older who screened positive for delirium during hospitalization. Relationships between patient characteristics, nursing interventions, and discharge dispositions were analyzed using chi-square tests and logistic regression. RESULTS Most participants (69.3%) were discharged to non-home facilities. Delayed urinary catheter removal was a significant nursing intervention factor. Patients with delayed urinary catheter removal were at increased risk of being discharged to a non-home setting compared with those with early urinary catheter removal (aOR: 14.11, P = .010). Preoperative hypoalbuminemia and surgery durations exceeding 60 minutes were associated with non-home dispositions. CONCLUSION Delayed urinary catheter removal, surgery duration greater than 1 hour, and preoperative hypoalbuminemia increased the likelihood of non-home discharge placement for older adults who experience postoperative delirium.
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Affiliation(s)
- Yunchuan Zhao
- Yunchuan Zhao is an associate professor at Boise State University in Boise, Idaho and a nurse at St. Luke's Health System, where Anna Quon is a manager of nursing research, Kayla Luke is an ICU RN, and Laura Tivis is the director of nursing research
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7
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Schreiber N, Reisinger AC, Hatzl S, Schneider N, Scholz L, Herrmann M, Kolland M, Schuller M, Kirsch AH, Eller K, Kink C, Fandler-Höfler S, Rosenkranz AR, Hackl G, Eller P. Biomarkers of alcohol abuse potentially predict delirium, delirium duration and mortality in critically ill patients. iScience 2023; 26:108044. [PMID: 37854697 PMCID: PMC10579439 DOI: 10.1016/j.isci.2023.108044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/30/2023] [Accepted: 09/21/2023] [Indexed: 10/20/2023] Open
Abstract
Carbohydrate-deficient transferrin (CDT) and the γ-glutamyltransferase-CDT derived Anttila-Index are established biomarkers for sustained heavy alcohol consumption and their potential role to predict delirium and mortality in critically ill patients is not clear. In our prospective observational study, we included 343 consecutive patients admitted to our ICU, assessed the occurrence of delirium and investigated its association with biomarkers of alcohol abuse measured on the day of ICU admission. 35% of patients developed delirium during ICU stay. We found significantly higher CDT levels (p = 0.011) and Anttila-Index (p = 0.001) in patients with delirium. CDT above 1.7% (OR 2.06), CDT per percent increase (OR 1.26, AUROC 0.75), and Anttila-Index per unit increase (OR 1.28, AUROC 0.74) were associated with delirium development in adjusted regression models. Anttila-Index and CDT also correlated with delirium duration exceeding 5 days. Additionally, Anttila-Index above 4, Anttila-Index per unit increase, and CDT per percent increase were independently associated with hospital mortality.
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Affiliation(s)
- Nikolaus Schreiber
- Department of Internal Medicine, Intensive Care Unit, Medical University of Graz, Graz, Austria
- Department of Internal Medicine, Division of Nephrology, Medical University of Graz, Graz, Austria
| | - Alexander C. Reisinger
- Department of Internal Medicine, Intensive Care Unit, Medical University of Graz, Graz, Austria
| | - Stefan Hatzl
- Department of Internal Medicine, Intensive Care Unit, Medical University of Graz, Graz, Austria
| | - Nikolaus Schneider
- Department of Internal Medicine, Intensive Care Unit, Medical University of Graz, Graz, Austria
| | - Laura Scholz
- Department of Internal Medicine, Intensive Care Unit, Medical University of Graz, Graz, Austria
| | - Markus Herrmann
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Michael Kolland
- Department of Internal Medicine, Division of Nephrology, Medical University of Graz, Graz, Austria
| | - Max Schuller
- Department of Internal Medicine, Division of Nephrology, Medical University of Graz, Graz, Austria
| | - Alexander H. Kirsch
- Department of Internal Medicine, Division of Nephrology, Medical University of Graz, Graz, Austria
| | - Kathrin Eller
- Department of Internal Medicine, Division of Nephrology, Medical University of Graz, Graz, Austria
| | - Christiane Kink
- Department of Internal Medicine, Intensive Care Unit, Medical University of Graz, Graz, Austria
| | | | - Alexander R. Rosenkranz
- Department of Internal Medicine, Division of Nephrology, Medical University of Graz, Graz, Austria
| | - Gerald Hackl
- Department of Internal Medicine, Intensive Care Unit, Medical University of Graz, Graz, Austria
| | - Philipp Eller
- Department of Internal Medicine, Intensive Care Unit, Medical University of Graz, Graz, Austria
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Delirium Risk Score in Elderly Patients with Cervical Spinal Cord Injury and/or Cervical Fracture. J Clin Med 2023; 12:jcm12062387. [PMID: 36983387 PMCID: PMC10054626 DOI: 10.3390/jcm12062387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 03/04/2023] [Accepted: 03/15/2023] [Indexed: 03/22/2023] Open
Abstract
The number of elderly patients with cervical trauma is increasing. Such patients are considered to be at high risk for delirium, which is an acute neuropsychological disorder that reduces the patient’s capacity to interact with their environment due to impairments in cognition. This study aimed to establish a risk score that predicts delirium in elderly patients with cervical SCI and/or cervical fracture regardless of treatment type. This retrospective cohort study included 1512 patients aged ≥65 years with cervical SCI and/or cervical fracture. The risk factors for delirium according to treatment type (surgical or conservative) were calculated using multivariate logistic regression. A delirium risk score was established as the simple arithmetic sum of points assigned to variables that were significant in the multivariate analyses. Based on the statistical results, the delirium risk score was defined using six factors: old age (≥80 years), hypoalbuminemia, cervical fracture, major organ injury, dependence on pre-injury mobility, and comorbid diabetes. The score’s area under the curve for the prediction of delirium was 0.66 (p < 0.001). Although the current scoring system must be validated with an independent dataset, the system remains beneficial because it can be used after screening examinations upon hospitalization and before deciding the treatment strategy.
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Kim HJ, Lee S, Kim SH, Lee S, Sim JH, Ro YJ. Association of C-reactive protein to albumin ratio with postoperative delirium and mortality in elderly patients undergoing hip fracture surgery: A retrospective cohort study in a single large center. Exp Gerontol 2023; 172:112068. [PMID: 36549547 DOI: 10.1016/j.exger.2022.112068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 12/05/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Postoperative delirium is a common complication in elderly patients who have undergone hip fracture surgery. Since postoperative delirium is associated with poor outcomes and the treatment is very complicated, identifying the patients at high risk for delirium and providing more attentive care to prevent postoperative delirium is essential. In this study, we aimed to assess the association of an elevated C-reactive protein (CRP)/albumin ratio with the increased incidence of postoperative delirium in elderly people who had undergone hip fracture surgery. METHODS A total of 629 patients who underwent hip fracture surgery between January 2014 and December 2018 were retrospectively analyzed. Patients were classified into two groups according to preoperative CRP/albumin cut-off levels (<1.5 and ≥1.5). We performed a propensity score matching analysis to compare the incidence of postoperative delirium and overall mortality between the two groups. Multivariate logistic regression and Cox regression analyses were performed to examine the association of the preoperative CRP/albumin ratio with postoperative delirium and overall mortality. RESULTS There were significant differences in the incidence of postoperative delirium (18.0 % vs. 35.8 %, P < 0.001) and overall mortality (26.7 % vs. 46.9 %, P < 0.001) between the groups before matching. We also observed significant differences in the incidence of postoperative delirium (20.7 % vs. 32.7 %, P = 0.019) and overall mortality (34.7 % vs. 46.0 %, P = 0.046) between the groups after matching. A high CRP/albumin ratio (≥1.5) was significantly associated with a higher incidence of postoperative delirium (adjusted odds ratio [OR]: 2.11, 95 % confidence interval [CI]: 1.40-3.18, P < 0.001) and a higher rate of overall mortality (adjusted hazard ratio [HR]: 1.44, 95 % CI: 1.07-1.93, P = 0.015). CONCLUSION Preoperative CRP/albumin ratio might be an independent risk factor of postoperative delirium and surgical prognosis in elderly patients undergoing hip fracture surgery.
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Affiliation(s)
- Ha-Jung Kim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sooho Lee
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University, College of Medicine, International St. Mary's hospital, Incheon, South Korea
| | - Sung-Hoon Kim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sangho Lee
- Department of Anesthesiology and Pain Medicine, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Ji-Hoon Sim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Young-Jin Ro
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Ormseth CH, LaHue SC, Oldham MA, Josephson SA, Whitaker E, Douglas VC. Predisposing and Precipitating Factors Associated With Delirium: A Systematic Review. JAMA Netw Open 2023; 6:e2249950. [PMID: 36607634 PMCID: PMC9856673 DOI: 10.1001/jamanetworkopen.2022.49950] [Citation(s) in RCA: 41] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
IMPORTANCE Despite discrete etiologies leading to delirium, it is treated as a common end point in hospital and in clinical trials, and delirium research may be hampered by the attempt to treat all instances of delirium similarly, leaving delirium management as an unmet need. An individualized approach based on unique patterns of delirium pathophysiology, as reflected in predisposing factors and precipitants, may be necessary, but there exists no accepted method of grouping delirium into distinct etiologic subgroups. OBJECTIVE To conduct a systematic review to identify potential predisposing and precipitating factors associated with delirium in adult patients agnostic to setting. EVIDENCE REVIEW A literature search was performed of PubMed, Embase, Web of Science, and PsycINFO from database inception to December 2021 using search Medical Subject Headings (MeSH) terms consciousness disorders, confusion, causality, and disease susceptibility, with constraints of cohort or case-control studies. Two reviewers selected studies that met the following criteria for inclusion: published in English, prospective cohort or case-control study, at least 50 participants, delirium assessment in person by a physician or trained research personnel using a reference standard, and results including a multivariable model to identify independent factors associated with delirium. FINDINGS A total of 315 studies were included with a mean (SD) Newcastle-Ottawa Scale score of 8.3 (0.8) out of 9. Across 101 144 patients (50 006 [50.0%] male and 49 766 [49.1%] female patients) represented (24 015 with delirium), studies reported 33 predisposing and 112 precipitating factors associated with delirium. There was a diversity of factors associated with delirium, with substantial physiological heterogeneity. CONCLUSIONS AND RELEVANCE In this systematic review, a comprehensive list of potential predisposing and precipitating factors associated with delirium was found across all clinical settings. These findings may be used to inform more precise study of delirium's heterogeneous pathophysiology and treatment.
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Affiliation(s)
- Cora H. Ormseth
- Department of Emergency Medicine, University of California, San Francisco
| | - Sara C. LaHue
- Department of Neurology, University of California, San Francisco
| | - Mark A. Oldham
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
| | | | - Evans Whitaker
- University of California, San Francisco, School of Medicine
| | - Vanja C. Douglas
- Department of Neurology, University of California, San Francisco
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Kim TW, Ko RE, Na SJ, Chung CR, Choi KH, Park CM, Yang JH. Associations of albumin and nutritional index factors with delirium in patients admitted to the cardiac intensive care unit. Front Cardiovasc Med 2023; 10:1100160. [PMID: 36937934 PMCID: PMC10020190 DOI: 10.3389/fcvm.2023.1100160] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 02/14/2023] [Indexed: 03/06/2023] Open
Abstract
Background Limited data are available on the association of malnutrition with the occurrence of delirium in the cardiac intensive care unit (CICU). Thus, we aimed to analyze whether nutritional indices and their components can predict the development of delirium in CICU. Methods We enrolled 2,783 patients admitted to the CICU of Samsung Medical Center for more than 24 h between September 2012 and December 2018. We assessed the nutritional status at admission using three indices, the Prognostic Nutrition Index (PNI), the Geriatric Nutritional Risk Index (GNRI), and the Controlling Nutritional Status (CONUT). Then, we compared predictive performances for the occurrence of delirium among nutritional indices using Delong's test. Results Delirium developed in 678 patients (24.3%) assessed three times daily for 7 days of CICU stay. Nutritional indices had fair predictive performance for development of delirium in critically ill cardiac patients using the area under the receiver-operating characteristic curve (AUROC: 0.729 for the GNRI, 0.728 for PNI, and 0.762 for CONUT). Furthermore, the AUROC of albumin alone (0.77, 95% CI, 0.75-0.79) was significantly greater than that of either GNRI (p < 0.001) or PNI (p < 0.001). In a multivariable analysis including each component of nutritional indices, albumin was a significant predictor for delirium but not absolute lymphocyte count, bodyweight/ideal bodyweight, or total cholesterol level as a component of nutritional indices. Conclusion Predictive performances of nutritional indices for the occurrence of delirium were acceptable in patients admitted to CICU. Albumin alone might be a helpful and straightforward indicator for the occurrence of delirium.
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Affiliation(s)
- Tae Wan Kim
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ryoung Eun Ko
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Soo Jin Na
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Chi Ryang Chung
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ki Hong Choi
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Chi-Min Park
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jeong Hoon Yang
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- *Correspondence: Jeong Hoon Yang,
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12
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Jiang L, Lei G. Albumin/fibrinogen ratio, an independent risk factor for postoperative delirium after total joint arthroplasty. Geriatr Gerontol Int 2022; 22:412-417. [PMID: 35365967 DOI: 10.1111/ggi.14381] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 02/09/2022] [Accepted: 03/08/2022] [Indexed: 12/16/2022]
Abstract
AIM Postoperative delirium (POD) is a very common and serious complication after total joint arthroplasty (TJA), which is closely associated with many adverse consequences and a poor prognosis. This study aimed to establish the potential risk factors for POD. METHODS In total, 336 patients who underwent elective TJA under general anesthesia between 2018 and 2021 were included and deemed eligible for inclusion. POD was diagnosed based on the criteria by the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM V). The receiver operating characteristic curve was drawn to evaluate the predictive and cut-off values of continuous variables for POD. Potential risk factors for POD were evaluated by binary univariate and multivariate analysis with the "Enter" method. RESULTS According to the criteria by DSM V, 43 patients were categorized into the POD group, with an incidence of 12.8% (43 of 336). The receiver operating characteristic curve showed that albumin/fibrinogen ratio (AFR) was a good predictor for POD with an area under the curve of 0.754, cut-off value of 9.65, sensitivity of 57.00% and specificity of 83.72% (P <0.001). A low preoperative AFR level (<9.65) was determined as the only independent risk factor for POD by the univariate and multivariate logistic regression analyses (OR: 2.45, 95% CI: 2.01-2.94, P = 0.008). CONCLUSIONS Our results indicate that a low AFR is an independent risk factor for POD in elderly subjects after TJA. Geriatr Gerontol Int 2022; 22: 412-417.
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Affiliation(s)
- Liuying Jiang
- Department of Anesthesiology, Zhongshan Hospital Xiamen University, Xiamen City, China
| | - Gaofeng Lei
- Xiamen Medical Emergency Center, Xiamen City, China
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13
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Li CQ, Zhang C, Yu F, Li XY, Wang DX. The composite risk index based on frailty predicts postoperative complications in older patients recovering from elective digestive tract surgery: a retrospective cohort study. BMC Anesthesiol 2022; 22:7. [PMID: 34979937 PMCID: PMC8722296 DOI: 10.1186/s12871-021-01549-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 12/17/2021] [Indexed: 12/21/2022] Open
Abstract
Background Limitations exist in available studies investigating effect of preoperative frailty on postoperative outcomes. This study was designed to analyze the association between composite risk index, an accumulation of preoperative frailty deficits, and the risk of postoperative complications in older patients recovering from elective digestive tract surgery. Methods This was a retrospective cohort study. Baseline and perioperative data of older patients (age ≥ 65 years) who underwent elective digestive tract surgery from January 1, 2017 to December 31, 2018 were collected. The severity of frailty was assessed with the composite risk index, a composite of frailty deficits including modified frailty index. The primary endpoint was the occurrence of postoperative complications during hospital stay. The association between the composite risk index and the risk of postoperative complications was assessed with a multivariable logistic regression model. Results A total of 923 patients were included. Of these, 27.8% (257) developed postoperative complications. Four frailty deficits, i.e., modified frailty index ≥0.27, malnutrition, hemoglobin < 90 g/L, and albumin ≤30 g/L, were combined to generate a composite risk index. Multivariable analysis showed that, when compared with patients with composite risk index of 0, the odds ratios (95% confidence intervals) were 2.408 (1.714–3.383, P < 0.001) for those with a composite risk index of 1, 3.235 (1.985–5.272, P < 0.001) for those with a composite risk index of 2, and 9.227 (3.568–23.86, P < 0.001) for those with composite risk index of 3 or above. The area under receiver-operator characteristic curve to predict postoperative complications was 0.653 (95% confidence interval 0.613–0.694, P < 0.001) for composite risk index compared with 0.622 (0.581–0.663, P < 0.001) for modified frailty index. Conclusion For older patients following elective digestive tract surgery, high preoperative composite risk index, a combination of frailty deficits, was independently associated with an increased risk of postoperative complications. Supplementary Information The online version contains supplementary material available at 10.1186/s12871-021-01549-6.
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Affiliation(s)
- Chun-Qing Li
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, No. 8, Xishiku Street, Beijing, 100034, China
| | - Chen Zhang
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, No. 8, Xishiku Street, Beijing, 100034, China
| | - Fan Yu
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, No. 8, Xishiku Street, Beijing, 100034, China
| | - Xue-Ying Li
- Department of Biostatistics, Peking University First Hospital, Beijing, China
| | - Dong-Xin Wang
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, No. 8, Xishiku Street, Beijing, 100034, China. .,Outcomes Research Consortium, Cleveland, OH, USA.
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14
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Silva AR, Regueira P, Albuquerque E, Baldeiras I, Cardoso AL, Santana I, Cerejeira J. Estimates of Geriatric Delirium Frequency in Noncardiac Surgeries and Its Evaluation Across the Years: A Systematic Review and Meta-analysis. J Am Med Dir Assoc 2020; 22:613-620.e9. [PMID: 33011097 DOI: 10.1016/j.jamda.2020.08.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 07/26/2020] [Accepted: 08/13/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Delirium is an acute neuropsychiatric syndrome associated with poor outcomes. Older adults undergoing surgery have a higher risk of manifesting perioperative delirium, particularly those having associated comorbidities. It remains unclear whether delirium frequency varies across surgical settings and if it has remained stable across the years. We conducted a systematic review to (1) determine the overall frequency of delirium in older people undergoing noncardiac surgery; (2) explore factors explaining the variability of the estimates; and (3) determine the changing of the estimates over the past 2 decades. DESIGN Systematic review and meta-analysis. Literature search was performed in MEDLINE, PubMed, ISI Web of Science, EBSCO, ISRCTN registry, ScienceDirect, and Embase in January 2020 for studies published from 1995 to 2020. SETTING Noncardiac surgical settings. PARTICIPANTS Forty-nine studies were included with a total of 26,865 patients screened for delirium. METHODS We included observational and controlled trials reporting incidence, prevalence, or proportion of delirium in adults aged ≥60 years undergoing any noncardiac surgery requiring hospitalization. Data extracted included sample size, reported delirium frequencies, surgery type, anesthesia type, delirium diagnosis method, length of hospitalization, and year of assessment. (PROSPERO registration no.: CRD42020160045). RESULTS We found an overall pooled frequency of preoperative delirium of 17.9% and postoperative delirium (POD) of 23.8%. The POD estimates increased between 1995 and 2020 at an average rate of 3% per year. Pooled estimates of POD were significantly higher in studies not excluding patients with lower cognitive performance before surgery (28% vs 16%) and when general anesthesia was used in comparison to local, spinal, or epidural anesthesia (28% vs 20%). CONCLUSIONS AND IMPLICATIONS Type of anesthesia and preoperative cognitive status were significant moderators of delirium frequency. POD in noncardiac surgery has been increasing across the years, suggesting that more resources should be allocated to delirium prevention and management.
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Affiliation(s)
- Ana Rita Silva
- Centre for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal; Coimbra Institute for Clinical and Biomedical Research (iCBR), Coimbra, Portugal
| | - Patrícia Regueira
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Coimbra, Portugal; Department of Psychiatry, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal; Faculty of Medicine, Coimbra University, Coimbra, Portugal
| | - Elisabete Albuquerque
- Department of Psychiatry, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - Inês Baldeiras
- Centre for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal; Coimbra Institute for Clinical and Biomedical Research (iCBR), Coimbra, Portugal; Faculty of Medicine, Coimbra University, Coimbra, Portugal
| | - Ana Luísa Cardoso
- Centre for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal; Coimbra Institute for Clinical and Biomedical Research (iCBR), Coimbra, Portugal
| | - Isabel Santana
- Centre for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal; Faculty of Medicine, Coimbra University, Coimbra, Portugal; Department of Neurology, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - Joaquim Cerejeira
- Centre for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal; Coimbra Institute for Clinical and Biomedical Research (iCBR), Coimbra, Portugal; Department of Psychiatry, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal; Faculty of Medicine, Coimbra University, Coimbra, Portugal.
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15
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Antipsychotic Drugs in Prevention of Postoperative Delirium-What Is Known in 2020? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176069. [PMID: 32825428 PMCID: PMC7503241 DOI: 10.3390/ijerph17176069] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/11/2020] [Accepted: 08/18/2020] [Indexed: 12/14/2022]
Abstract
Delirium is one of the most frequently reported neuropsychiatric complications in the perioperative period, especially in the population of elderly patients who often suffer from numerous comorbidities undergoing extensive or urgent surgery. It can affect up to 80% of patients who require hospitalization in an intensive care setting postoperatively. Delirium increases mortality, morbidity, length of hospital stay, and cost of treatment. An episode of delirium in the acute phase may lower the general quality of life and increases the risk of cognitive decline long-term. Since pharmacological treatment of delirium is not highly effective, focus of research has shifted towards developing preventive strategies. We aimed to perform a review of the topic based on the most recent literature. We conclude that, based on the available data, it seems impossible to make strong recommendations for using antipsychotic drugs in prophylaxis. Further research should answer the question what, if any, benefit patients receive from the pharmacological prevention of delirium, and which agents should be used.
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16
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Qi J, Liu C, Chen L, Chen J. Postoperative Serum Albumin Decrease Independently Predicts Delirium in the Elderly Subjects after Total Joint Arthroplasty. Curr Pharm Des 2020; 26:386-394. [PMID: 31880243 DOI: 10.2174/1381612826666191227153150] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 12/23/2019] [Indexed: 12/30/2022]
Abstract
Background:
Postoperative delirium (POD), a neurobehavioral syndrome induced by dysfunction of
neural activity, is a common and serious complication. This current study aimed to investigate independent predictors
for POD in elderly subjects after total joint arthroplasty (TJA).
Methods:
Eligible elderly patients (≥65 years) who underwent elective unilateral primary hip or knee arthroplasty
under epidural anesthesia from October 2016 to January 2019 were consecutively enrolled. POD was diagnosed
following the guidance of the 5th edition of Diagnostic and Statistical Manual of Mental Disorders, (DSM V,
2013). The relative change in serum Alb (ΔAlb) was defined as the absolute value of (preoperative Alb value–
nadir value within postoperative day 2)/preoperative Alb ×100%. The predictive value of ΔAlb for POD was
evaluated by receiver operating characteristic (ROC) curve analysis. Univariate and multivariate logistic regression
analyses were used for evaluating risk factors for POD.
Results:
A total of 328 patients were enrolled in the analysis, of which 68 (20.7%, 68/328) patients developed
POD within postoperative 7 days. ΔAlb was an effective predictor for POD with an area under the curve (AUC)
of 0.821, a sensitivity of 76.15% and a specificity of 70.59%, respectively (P<0.001). Univariate and multivariate
logistic regression analyses indicated that ΔAlb was the only independent risk factor for POD (OR: 2.43, 95%CI:
1.17–4.86, P=0.015).
Conclusions:
ΔAlb was an independent risk factor for POD in elderly subjects after TJA.
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Affiliation(s)
- Jianmin Qi
- Department of anesthesiology, HwaMei Hospital, University of Chinese Academy of Sciences, Beijing, China
| | - Cheng Liu
- Department of anesthesiology, HwaMei Hospital, University of Chinese Academy of Sciences, Beijing, China
| | - Li'an Chen
- Department of anesthesiology, HwaMei Hospital, University of Chinese Academy of Sciences, Beijing, China
| | - Junping Chen
- Department of anesthesiology, HwaMei Hospital, University of Chinese Academy of Sciences, Beijing, China
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Wang J, Ji Y, Wang N, Chen W, Bao Y, Qin Q, Ma C, Xiao Q, Li S. Establishment and validation of a delirium prediction model for neurosurgery patients in intensive care. Int J Nurs Pract 2020; 26:e12818. [PMID: 32011790 DOI: 10.1111/ijn.12818] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 08/28/2019] [Accepted: 01/05/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Jun Wang
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University Beijing China
| | - Yuanyuan Ji
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University Beijing China
| | - Ning Wang
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University Beijing China
| | - Wenjin Chen
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University Beijing China
| | - Yuehong Bao
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University Beijing China
| | - Qinpu Qin
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University Beijing China
| | - Chunmei Ma
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University Beijing China
| | - Qian Xiao
- School of Nursing Capital Medical University Beijing China
| | - Shulan Li
- School of Nursing Capital Medical University Beijing China
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18
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Preoperative C-Reactive Protein/Albumin Ratio, a Risk Factor for Postoperative Delirium in Elderly Patients After Total Joint Arthroplasty. J Arthroplasty 2019; 34:2601-2605. [PMID: 31326244 DOI: 10.1016/j.arth.2019.06.042] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 06/18/2019] [Accepted: 06/18/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Postoperative delirium (POD), as an acute brain failure, is widely reported as a very common postoperative complication, and it is closely associated with increased morbidity and mortality. This study aimed to investigate potential risk factors including C-reactive protein/albumin ratio (CAR) for POD in elderly subjects after total joint arthroplasty (TJA). METHODS A total of 272 elderly patients (aged 65∼85 years) who were scheduled to undergo elective TJA with epidural anesthesia were consecutively recruited. The data of baseline characteristics, operation-associated indexes, and preoperative laboratory tests were collected. POD assessment was performed daily within postoperative 7 days. Receiver operating characteristic curve analysis was utilized for evaluating the predictive and cut-off value of CAR for POD. Risk factors for POD were evaluated by the binary univariate and multivariate logistic regression analyses. RESULTS Within postoperative 7 days, there were 55 patients who had suffered POD with an incidence of 20.2% (55/272). The area under the curve of CAR for POD was 0.804, with the cut-off value of 2.35, a sensitivity of 66.82%, and a specificity of 80.00%, respectively (95% confidence interval [CI]: 0.737-0.872, P < .001). Age (odds ratio: 2.02, 95% CI: 1.03-3.96, P = .038) and preoperative CAR level (odds ratio: 3.04, 95% CI: 1.23-7.23, P = .016) were 2 independent risk factors for POD in elderly subjects undergoing TJA. CONCLUSIONS Preoperative CAR level may be a promising predictor for POD in elderly subjects following TJA.
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19
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Toft K, Tontsch J, Abdelhamid S, Steiner L, Siegemund M, Hollinger A. Serum biomarkers of delirium in the elderly: a narrative review. Ann Intensive Care 2019; 9:76. [PMID: 31263968 PMCID: PMC6603109 DOI: 10.1186/s13613-019-0548-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 06/20/2019] [Indexed: 12/17/2022] Open
Abstract
Delirium after surgery and in the intensive care unit (ICU) remains a challenge for patients, families, and caregivers. Over the years, many promising biomarkers have been investigated as potential instruments for risk stratification of delirium. This review aimed to identify and assess the clinical usefulness of candidate serum biomarkers associated with hospital delirium in patients aged 60 years and older. We performed a time-unlimited review of publications indexed in PubMed, Cochrane, Embase, and MEDLINE databases until June 2019 that evaluated baseline and/or longitudinal biomarker measurements in patients suffering from delirium at some point during their hospital stay. A total of 32 studies were included in this review reporting information on 7610 patients. Of these 32 studies, twenty-four studies reported data from surgical patients including four studies in ICU cohorts, five studies reported data from medical patients (1026 patients), and three studies reported data from a mixed cohort (1086 patients), including one study in an ICU cohort. Findings confirm restricted clinical usefulness to predict or diagnose delirium due to limited evidence on which biomarkers can be used and limited availability due to non-routine use.
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Affiliation(s)
- Katharina Toft
- Department for Anesthesia, Intensive Care and Emergency Medicine, See-Spital, Horgen, Kilchberg, Switzerland.,Institute for Anesthesia and Intensive Care, Hirslanden Klinik Zurich, Zurich, Switzerland
| | - Janna Tontsch
- Department for Intensive Care, University Hospital Basel, Basel, Switzerland
| | - Salim Abdelhamid
- Department for Intensive Care, University Hospital Basel, Basel, Switzerland
| | - Luzius Steiner
- Medical Faculty of the University of Basel, Basel, Switzerland.,Department for Anesthesia, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland
| | - Martin Siegemund
- Department for Intensive Care, University Hospital Basel, Basel, Switzerland.,Medical Faculty of the University of Basel, Basel, Switzerland
| | - Alexa Hollinger
- Department for Intensive Care, University Hospital Basel, Basel, Switzerland.
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20
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Ayob F, Lam E, Ho G, Chung F, El-Beheiry H, Wong J. Pre-operative biomarkers and imaging tests as predictors of post-operative delirium in non-cardiac surgical patients: a systematic review. BMC Anesthesiol 2019; 19:25. [PMID: 30797230 PMCID: PMC6387490 DOI: 10.1186/s12871-019-0693-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 02/08/2019] [Indexed: 02/06/2023] Open
Abstract
Background Post-operative delirium (POD) is a common post-operative complication in elderly individuals and imposes a significant health and financial burden. Identifying predictive biomarkers may help understand the pathophysiology of POD. Our objective is to summarize the evidence of pre-operative biomarkers and imaging tests to predict POD in patients undergoing non-cardiac surgery. Methods A systematic search of English language articles in MEDLINE, EMBASE, Cochrane Database, PsychINFO, PubMed and ClinicalTrials. Gov up to January 2018 was performed. Studies that used biomarkers or imaging tests to predict POD and a validated POD assessment tool were included. Animal studies, paediatric, cardiac and intracranial surgery were excluded. Risk of bias was assessed using the Quality In Prognosis Study tool. Results Thirty-four prospective cohort studies involving 4424 patients were included. Nineteen studies described serum tests [Interleukin-6, Insulin-like Growth Factor 1, C-Reactive Protein (CRP), cholinesterases, apolipoprotein-E genotype, leptin, hypovitaminosis, hypoalbuminaemia, gamma-amino butyric acid], 10 described cerebral-spinal fluid tests (monoamine precursor, melatonin, acute phase proteins, S100B and neurofibrillary tangles), and 5 described imaging tests. Two studies had high risk of bias due to unclear outcome measurement and study participation. CRP was significantly associated with POD in 5 studies. Other biomarkers were either examined by only a single study or two or more studies with conflicting results. Conclusion CRP is the most promising biomarker associated with POD. However, we are still in the early stages in identifying biomarkers and imaging tests that may further understanding of the pathophysiology of POD. Electronic supplementary material The online version of this article (10.1186/s12871-019-0693-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Farrah Ayob
- Department of Anesthesia, Toronto Western Hospital, University Health Network, 2-434 McLaughlin Wing, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada
| | - Enoch Lam
- Department of Anesthesia, Toronto Western Hospital, University Health Network, 2-434 McLaughlin Wing, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada
| | - George Ho
- Faculty of Medicine, University of Toronto, 1 King's College Circle, Medical Sciences Building, Room 2109, Toronto, ON, M5S 1A8, Canada
| | - Frances Chung
- Department of Anesthesia, Toronto Western Hospital, University Health Network, 2-434 McLaughlin Wing, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada
| | - Hossam El-Beheiry
- Department of Anesthesia, Trillium Health Partners, Mississauga Hospital, 100 Queensway, West, Mississauga, ON, L5B 1B, Canada
| | - Jean Wong
- Department of Anesthesia, Toronto Western Hospital, University Health Network, 2-434 McLaughlin Wing, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada. .,Women's College Hospital, Toronto, Ontario, 76 Grenville St, Toronto, ON, M5S 1B2, Canada.
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21
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Zhang DF, Wang DX. Response to a letter to the editor. J Crit Care 2017; 44:469-470. [PMID: 29137832 DOI: 10.1016/j.jcrc.2017.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 11/06/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Dan-Feng Zhang
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, No. 8 Xishiku Street, Beijing 100034, China; Department of Anesthesiology, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou 350001, China
| | - Dong-Xin Wang
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, No. 8 Xishiku Street, Beijing 100034, China.
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