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Vasunilashorn SM, Wolfson E, Berger M, Leung J, Ware EB, Baccarelli A, Jones RN, Ngo LH, Marcantonio ER, Inouye SK, Kind AJH. Multi-level social determinants of health, inflammation, and postoperative delirium in older adults. J Am Geriatr Soc 2024. [PMID: 39206865 DOI: 10.1111/jgs.19159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 07/30/2024] [Accepted: 08/01/2024] [Indexed: 09/04/2024]
Affiliation(s)
- Sarinnapha M Vasunilashorn
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Emily Wolfson
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Miles Berger
- Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jacqueline Leung
- Department of Anesthesiology, University of California, San Francisco, San Francisco, California, USA
| | - Erin B Ware
- Institute of Social Research Survey Research Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Andrea Baccarelli
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Richard N Jones
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
- Department of Neurology, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Long H Ngo
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Edward R Marcantonio
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Sharon K Inouye
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA
| | - Amy J H Kind
- Center for Health Disparities Research, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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Yoldas TK, Sahutoglu C, Kaynarca O, Bor C. Correlation Between Sociocultural and Economic Factors in Pediatric Patients' Families and Emergence Delirium. Cureus 2023; 15:e46229. [PMID: 37829987 PMCID: PMC10565521 DOI: 10.7759/cureus.46229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Postoperative delirium is a commonly encountered condition that can arise from multiple factors, and its occurrence varies based on the type of surgery in pediatric patients. This study aimed to investigate the occurrence of delirium during the recovery from anesthesia in children undergoing eye surgery and its association with the sociocultural and economic status of their families. METHODS This prospective observational study included children aged 2-12 years who underwent eye surgeries. Demographic data, socioeconomic and educational status of parents, parental separation and cooperation scores, Cravero agitation score, and face, legs, activity, cry, and consolability (FLACC) score (at zero, five, 15, and 30 minutes in the postoperative period) were recorded. Patients who scored 5 on the Cravero agitation scale for at least five minutes were considered to have postoperative delirium. The STROBE checklist was followed for reporting. RESULTS A total of 104 patients were included in the study, of which 65 were male. The mean age of the patients was 6.5±2.9 years, and 42 patients (40.4%) belonged to the preschool age group. The incidence of delirium was found to be 51.9%. Delirium was found to be associated with postoperative pain (p=0.003), age (p=0.001), preoperative anxiety (not cooperative examination score (p=0.047), poor separation score (p=0.006)), presence of a surgical history (p=0.012), and cataract surgery (p=0.007). No evidence was found to demonstrate a link between sociocultural and economic conditions and the development of delirium. CONCLUSIONS This study identified several factors that influenced the occurrence of delirium, including postoperative pain (FLACC≥4), younger age (<6 years), cataract surgery, presence of surgical history, examination score (score 3, not cooperative), and separation score (scores 3-4, poor).
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Affiliation(s)
- Tuba K Yoldas
- Anesthesiology and Reanimation, Ege University School of Medicine, İzmir, TUR
| | - Cengiz Sahutoglu
- Anesthesiology and Reanimation, Ege University School of Medicine, İzmir, TUR
| | - Ozgecan Kaynarca
- Anesthesiology and Reanimation, Ege University School of Medicine, İzmir, TUR
| | - Canan Bor
- Anesthesiology and Reanimation, Ege University School of Medicine, İzmir, TUR
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Shyam R, Patel ML, Solanki M, Sachan R, Ali W. Correlation of C-reactive Protein with Delirium in Obstetrics Intensive Care Unit: A Tertiary Center Experience. Indian J Crit Care Med 2023; 27:315-321. [PMID: 37214122 PMCID: PMC10196652 DOI: 10.5005/jp-journals-10071-24455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 03/27/2023] [Indexed: 05/24/2023] Open
Abstract
Background Delirium is a neuropsychiatric illness. It affects critically ill patients on ventilator and increases mortality. The aim of this study was to evaluate the association of C-reactive protein (CRP) level with delirium in critically obstetrics women and its role in prediction of delirium. Materials and methods Arospective observational study was conducted in the intensive care unit (ICU), and the duration of study was one year. Total 145 subjects were recruited, 33 patients were excluded, and 112 subjects were studied. For study, group A (n = 36) includes critically ill obstetric women who had delirium on admission; group B (n = 37) includes critically ill obstetric women who developed delirium within 7 days; and group C (n = 39) that includes critically ill obstetric women who did not develop delirium after follow-up of 7 days was served as control. Disease severity was assessed by using acute physiologic assessment and chronic health evaluation (APACHE) II score, and Richmond Agitation-Sedation Scale (RASS) was used to assess awakeness. In awake patients (RASS of ≥3), delirium was assessed by the use of confusion assessment method for ICU tools. C-reactive protein measured by particle enhanced turbidimetric immunoassay-two point kinetic method. Results The mean ages of group A, B, and C were 26.44 ± 4.72, 27.46 ± 4.97, and 28.26 ± 5.67 years, respectively. C-reactive protein levels on the day of delirium development (group B) were found to be significantly higher than day 1 CRP levels of groups A and C. The mean Global Attentiveness Rating (GAR) was significantly lower in groups A and B as compared to that in group C (p < 0.001). On evaluating the correlation of CRP with GAR, it was found to be inverse and mild in strength for the correlation between CRP and GAR (r = -0.403, p < 0.001). At a cut-off value of >181 mg/L, CRP had sensitivity of 93.2% and specificity of 69.2%. The positive predictive value was 85% and the negative predictive value was 84.4% that differentiate delirium from non-delirium. Conclusion C-reactive protein is a useful tool for screening and prediction of delirium in critically ill obstetric patients. How to cite this article Shyam R, Patel ML, Solanki M, Sachan R, Ali W. Correlation of C-reactive Protein with Delirium in Obstetrics Intensive Care Unit: A Tertiary Center Experience. Indian J Crit Care Med 2023;27(5):315-321.
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Affiliation(s)
- Radhey Shyam
- Department of Geriatric Mental Health and Critical Care, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Munna Lal Patel
- Department of Internal Medicine, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Monam Solanki
- Department of Obstetrics and Gynecology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Rekha Sachan
- Department of Obstetrics and Gynecology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Wahid Ali
- Department of Pathology, King George's Medical University, Lucknow, Uttar Pradesh, India
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Pereira DN, Bicalho MAC, Jorge ADO, Gomes AGDR, Schwarzbold AV, Araújo ALH, Cimini CCR, Ponce D, Rios DRA, Grizende GMS, Manenti ERF, Anschau F, Aranha FG, Bartolazzi F, Batista JDL, Tupinambás JT, Ruschel KB, Ferreira MAP, Paraíso PG, Araújo SF, Teixeira AL, Marcolino MS. Neurological manifestations by sex and age group in COVID-19 inhospital patients. eNeurologicalSci 2022; 28:100419. [PMID: 35935176 PMCID: PMC9338167 DOI: 10.1016/j.ensci.2022.100419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 07/15/2022] [Accepted: 07/24/2022] [Indexed: 01/08/2023] Open
Abstract
Introduction Neurological manifestations have been associated with a poorer prognosis in COVID-19. However, data regarding their incidence according to sex and age groups is still lacking. Methods This retrospective multicentric cohort collected data from 39 Brazilian hospitals from 17 cities, from adult COVID-19 admitted from March 2020 to January 2022. Neurological manifestations presented at hospital admission were assessed according to incidence by sex and age group. Results From 13,603 COVID-19 patients, median age was 60 years old and 53.0% were men. Women were more likely to present with headaches (22.4% vs. 17.7%, p < 0.001; OR 1.36, 95% confidence interval [CI] 1.22-1.52) than men and also presented a lower risk of having seizures (OR 0.43, 95% CI 0.20-0.94). Although delirium was more frequent in women (6.6% vs. 5.7%, p = 0.020), sex was not associated with delirium in the multivariable logistc regresssion analysis. Delirium, syncope and coma increased with age (1.5% [18-39 years] vs. 22.4% [80 years or over], p < 0.001, OR 1.07, 95% CI 1.06-1.07; 0.7% vs. 1.7%, p = 0.002, OR 1.01, 95% CI 1.00-1.02; 0.2% vs. 1.3% p < 0.001, OR 1.04, 95% CI 1.02-1.06), while, headache (26.5% vs. 7.1%, OR 0.98, 95% CI 0.98-0.99), anosmia (11.4% vs. 3.3%, OR 0.99, 95% CI] 0.98-0.99 and ageusia (13.1% vs. 3.5%, OR 0.99, CI 0.98-0.99) decreased (p < 0.001 for all). Conclusion Older COVID-19 patients were more likely to present delirium, syncope and coma, while the incidence of anosmia, ageusia and headaches decreased with age. Women were more likely to present headache, and less likely to present seizures.
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Affiliation(s)
| | - Maria Aparecida Camargos Bicalho
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Brazil
- Fundação Hospitalar do Estado de Minas Gerais (Fhemig), Germany
| | - Alzira de Oliveira Jorge
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Brazil
- Hospital Risoleta Tolentino Neves, Brazil
| | | | | | | | - Christiane Corrêa Rodrigues Cimini
- Hospital Santa Rosália, Brazil
- Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Brazil
- Institute for Health Technology Assessment (IATS/ CNPq), Brazil
| | - Daniela Ponce
- Hospital das Clínicas da Faculdade de Medicina de Botucatu, Brazil
| | - Danyelle Romana Alves Rios
- Complexo da Saúde São João de Deus, Universidade Federal de São João del-Rei, Brazil
- Campus Centro Oeste Dona Lindu, Universidade Federal de São João del-Rei, Brazil
| | | | | | - Fernando Anschau
- Grupo Hospitalar Conceição, Brazilian National Health System, Hospital Nossa Senhora da Conceição and Hospital Cristo Redentor, Brazil
| | | | | | - Joanna d'Arc Lyra Batista
- Universidade Federal Fronteira do Sul, Brasil
- Instituto de Avaliação de Tecnologia em Saúde (IATS/CNPQ), Brazil
- Hospital Regional do Oeste, Brazil
| | | | - Karen Brasil Ruschel
- Hospital Mãe de Deus, Hospital Universitário de Canoas, Universidade Federal do Rio Grande do Sul e Instituto de Avaliação de Tecnologia em Saúde (IATS/CNPQ), Brazil
| | | | | | | | - Antonio Lucio Teixeira
- Faculdade Santa Casa BH, Brazil
- Neuropsychiatry Program, Department of Psychiatry and Behavioral Sciences, UT Health Houston, Brazil
| | - Milena Soriano Marcolino
- Department of Internal Medicine, Medical School, and Telehealth Center, University Hospital, Universidade Federal de Minas Gerais, Brazil
- Institute for Health Technology Assessment (IATS/ CNPq), Brazil
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