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Gholi Z, Rezaei M, Vahdat Shariatpanahi Z, Momen R, Fallah Bagher Shaidaei M, Gholami M, Aghaee S, Eskandari Sabzi H, Rajabi MR. Malnutrition elevates delirium and ICU stay among critically ill older adult COVID-19 patients. Front Med (Lausanne) 2024; 11:1259320. [PMID: 38799151 PMCID: PMC11116702 DOI: 10.3389/fmed.2024.1259320] [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: 09/22/2023] [Accepted: 04/29/2024] [Indexed: 05/29/2024] Open
Abstract
Background and aim Malnutrition among intensive care unit (ICU) patients is associated with a higher risk of mortality and prolonged hospitalization. However, the influence of malnutrition on severe outcomes of ICU patients with coronavirus disease 2019 (COVID-19) is unclear. By evaluating the effect of malnutrition on the outcomes of COVID-19 in the ICU in older adult patients, this study will contribute to new knowledge of assessing the nutritional status and recovery of these patients. Methods In the current single center prospective study, 310 critically ill COVID-19 patients with an age range of ≥65 years were recruited. Data on demographic characteristics, laboratory parameters, comorbidities, medications, and types of mechanical ventilation were collected in the first 24 h of ICU admission. Malnutrition was defined based on the two-step approach of the Global Leadership Initiative on Malnutrition (GLIM) scale at baseline. During the 45 days after the baseline, we collected data on delirium incidence, mortality, invasive mechanical ventilation (IMV) requirement, length of ICU and hospital admission, and re-hospitalization. Results In this study, the prevalence of malnutrition was 63.4% among critically ill COVID-19 patients. During the 45-day follow-up, 190 (61.3%) COVID-19 deaths were recorded among the baseline 310 patients. After controlling for potential confounders, malnutrition was associated with an increased risk of delirium so malnourished COVID-19 patients had a significantly 35% higher risk of delirium than those without malnutrition (HR: 1.35, 95% CI: 1.01-1.83). Such a significant association was not for COVID-19 mortality and IMV requirement. In addition, malnutrition was associated with a significantly 84% greater odds of prolonged ICU admission (OR: 1.84, 95% CI: 1.09-3.10). No significant association was seen between malnutrition and re-hospitalization and also prolonged hospital admission. Conclusion Malnutrition was associated with an increased risk of delirium and prolonged ICU admission among critically ill older adult COVID-19 patients. Prevention, diagnosis, and treatment of malnutrition could be a key component in improving outcomes in these patients.
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Affiliation(s)
- Zahra Gholi
- Minimally Invasive Surgery Research Center; Iran University of Medical Sciences, Tehran, Iran
| | - Masoud Rezaei
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
- Cardiovascular Nursing Research Center, Rajaie Cardiovascular Medical and Research Center, Tehran, Iran
| | - Zahra Vahdat Shariatpanahi
- Department of Clinical Nutrition and Dietetics, National Nutrition and Food Technology Research Institute, Faculty of Nutrition and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Momen
- MSc in Critical Care nursing, Instructor, Critical Care Nursing Department, Faculty of Nursing, Aja University of Medical Sciences, Tehran, Iran
| | | | - Mostafa Gholami
- Nursing and Midwifery Care Research Center, Health Management Research Institute, Iran University of Medical Science, Tehran, Iran
| | - Simin Aghaee
- Department of Pediatric Nursing, School of Nursing, Student Research Committee, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Hakimeh Eskandari Sabzi
- Dept. of Pediatric Nursing, School of Nursing and Midwifery, Ahvaz Jundishapour University Medical Sciences, Ahvaz, Iran, Ahvaz, Iran
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Mei X, Liu YH, Han YQ, Zheng CY. Risk factors, preventive interventions, overlapping symptoms, and clinical measures of delirium in elderly patients. World J Psychiatry 2023; 13:973-984. [PMID: 38186721 PMCID: PMC10768493 DOI: 10.5498/wjp.v13.i12.973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/14/2023] [Accepted: 10/30/2023] [Indexed: 12/19/2023] Open
Abstract
Delirium is an acute reversible neuropsychiatric syndrome caused by multiple factors. It is associated with many adverse clinical outcomes including cognitive impairment, functional decline, prolonged hospitalization, and increased nursing service. The prevalence of delirium was high in department of cardiology, geriatric, and intensive care unit of hospital. With the increase in the aged population, further increases in delirium seem likely. However, it remains poorly recognized in the clinical practice. This article comprehensively discusses the latest research perspectives on the epidemiological data, risk factors, preventive interventions, overlapping symptoms, and clinical measures of delirium, including specific measures to manage delirium in clinical real-world situations. This article helps readers improve their knowledge and understanding of delirium and helps clinicians quickly identify and implement timely therapeutic measures to address various delirium subtypes that occur in the clinical settings to ensure patients are treated as aggressively as possible.
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Affiliation(s)
- Xi Mei
- Department of Psychiatry, Ningo Kangning Hospital, Ningbo 315201, Zhejiang Province, China
| | - Yue-Hong Liu
- Department of Psychiatry, Ningo Kangning Hospital, Ningbo 315201, Zhejiang Province, China
| | - Ya-Qing Han
- Department of Psychiatry, Ningo Kangning Hospital, Ningbo 315201, Zhejiang Province, China
| | - Cheng-Ying Zheng
- Department of Psychiatry, Ningo Kangning Hospital, Ningbo 315201, Zhejiang Province, China
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Niu Z, Zhou J, Li Y. Prognostic significance of delirium in patients with heart failure: a systematic review and meta-analysis. Front Cardiovasc Med 2023; 10:1217965. [PMID: 37636295 PMCID: PMC10450942 DOI: 10.3389/fcvm.2023.1217965] [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: 05/06/2023] [Accepted: 08/02/2023] [Indexed: 08/29/2023] Open
Abstract
Background Delirium is a common symptom of heart failure (HF) and is associated with increased mortality, prolonged hospital stays, and heightened medical costs. The impact of delirium on the prognosis of HF patients is currently controversial. Therefore, we conducted a meta-analysis to evaluate the prognostic significance of delirium in HF. Methods Relevant articles were systematically searched in PubMed, Cochrane Library, Web of Science, and Embase based on the PRISMA guidelines. Studies that reported mortality and hospitalization-related outcomes in HF patients with or without delirium using raw or adjusted hazard ratio (HR) and odds ratio (OD) were included. Meta-analysis was then performed to evaluate the effect of delirium in HF patients. Outcomes of interest were all-cause mortality and events of the hospitalization. Results Of the 1,501 studies identified, 7 eligible studies involving 12,830,390 HF patients (6,322,846 males and 6,507,544 females) were included in the meta-analysis. There were 91,640 patients with delirium (0.71%) and 12,738,750 patients without delirium (99.28%). HF patients with delirium had higher OR for in-hospital mortality (1.95, 95% CI = 1.30-2.91, P = 0.135), higher pooled HR for 90-day mortality (2.64, 95% CI = 1.06-1.56, P = 0.215), higher pooled HR for 1-year mortality (2.08, 95% CI = 1.34-3.22, P = 0.004), and higher pooled HR for 30-day readmission rate (4.15, 95% CI = 2.85-6.04, P = 0.831) than those without delirium. Conclusion Current evidence suggests that combined delirium increases the risk of HF-related mortality and hospitalization-related outcomes in patients with HF. However, more research is needed to assess the impact of delirium on the prognosis of HF patients.
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Affiliation(s)
- Ziru Niu
- Department of Cardiovascular Medicine, The Second Hospital of HeBei Medical University, Shijiazhuang, China
| | - Jiamin Zhou
- Department of Hematology, The Second Hospital of HeBei Medical University, Shijiazhuang, China
| | - Yongjun Li
- Department of Cardiovascular Medicine, The Second Hospital of HeBei Medical University, Shijiazhuang, China
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Choi H, Park CS, Huh J, Koo J, Jeon J, Kim E, Jung S, Kim HW, Lim JY, Hwang W. Intraoperative Glycemic Variability and Mean Glucose are Predictors for Postoperative Delirium After Cardiac Surgery: A Retrospective Cohort Study. Clin Interv Aging 2022; 17:79-95. [PMID: 35153478 PMCID: PMC8827640 DOI: 10.2147/cia.s338712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 12/20/2021] [Indexed: 12/15/2022] Open
Abstract
Purpose Postoperative delirium (POD) is a common but serious complication after cardiac surgery and is associated with various short- and long-term outcomes. In this study, we investigated the effects of intraoperative glycemic variability (GV) and other glycemic variables on POD after cardiac surgery. Patients and Methods A retrospective single-center cohort analysis was conducted using data from electronic medical record from 2018 to 2020. A total of 705 patients undergoing coronary artery bypass graft surgery and/or valve surgery, and/or aortic replacement surgery were included in the analysis. Intraoperative GV was assessed with a coefficient of variation (CV), which was defined as the standard deviation of five intraoperative blood glucose measurements divided by the mean. POD assessment was performed three times a day in the ICU and twice a day in the ward until discharge by trained medical staff. POD was diagnosed if any of the Confusion Assessment Method for the Intensive Care Unit was positive in the ICU, and the Confusion Assessment Method was positive in the ward. Multivariable logistic regression was used to identify associations between intraoperative GV and POD. Results POD occurred in 306 (43.4%) patients. When intraoperative glycemic CV was compared as a continuous variable, the delirium group had higher intraoperative glycemic CV than the non-delirium group (22.59 [17.09, 29.68] vs 18.19 [13.00, 23.35], p < 0.001), and when intraoperative glycemic CV was classified as quartiles, the incidence of POD increased as intraoperative glycemic CV quartiles increased (first quartile 29.89%; second quartile 36.67%; third quartile 44.63%; and fourth quartile 62.64%, p < 0.001). In the multivariable logistic regression model, patients in the third quartile of intraoperative glycemic CV were 1.833 times (OR 1.833, 95% CI: 1.132–2.967, p = 0.014), and patients in the fourth quartile of intraoperative glycemic CV were 3.645 times (OR 3.645, 95% CI: 2.235–5.944, p < 0.001) more likely to develop POD than those in the first quartile of intraoperative glycemic CV. Conclusion Intraoperative blood glucose fluctuation, manifested by intraoperative GV, is associated with POD after cardiac surgery. Patients with a higher intraoperative GV have an increased risk of POD.
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Affiliation(s)
- Hoon Choi
- Department of Anesthesia and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chul Soo Park
- Department of Anesthesia and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jaewon Huh
- Department of Anesthesia and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jungmin Koo
- Department of Anesthesia and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Joonpyo Jeon
- Department of Anesthesia and Pain Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Eunsung Kim
- Department of Anesthesia and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sangmin Jung
- Department of Anesthesia and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hwan Wook Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ju Yong Lim
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Wonjung Hwang
- Department of Anesthesia and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Correspondence: Wonjung Hwang, Department of Anesthesia and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea, Tel +82-2-22586162, Fax +82-2-5371951, Email
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Zhang F, He ST, Zhang Y, Mu DL, Wang DX. Malnutrition is not related with emergence delirium in older patients after noncardiac surgery. BMC Geriatr 2021; 21:319. [PMID: 34001019 PMCID: PMC8130292 DOI: 10.1186/s12877-021-02270-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/04/2021] [Indexed: 11/27/2022] Open
Abstract
Background Delirium is one of the most common complications in older surgical patients. Although previous studies reported that preoperative malnutrition was related with postoperative delirium (POD), there was lack of evidence to illustrate the relationship between malnutrition and emergency delirium (ED). The objective of this study was to investigate the relationship between preoperative malnutrition and ED in older patients undergoing noncardiac surgery. Methods The study was carried out in accordance with STROBE guidelines. This was a secondary analysis of a prospective cohort study. Older patients (65–90 years) who underwent noncardiac surgery under general anesthesia were enrolled in Peking University First Hospital. Results 915 patients were enrolled. The incidence of malnutrition was 53.6 % (490/915). The incidence of emergency delirium was 41.8 % (205/490) in malnutrition group and 31.5 % (134/425) in control group, P < 0.001. After adjusting confounding factors (i.e., age, cognitive impairment, American Society of Anesthesiologists classification (ASA), duration of surgery, pain score, low body temperature and allogeneic blood transfusion), malnutrition was not associated with increased risk of emergency delirium (OR = 1.055, 95 % CI 0.767–1.452, P = 0.742). Conclusions Malnutrition was common in older patients undergoing non-cardiac surgery, but it’s not related with emergence delirium after adjusted for confounders. Trial registration Chinese Clinical Trial Registry (http://www.chictr.org.cn) (ChiCTR-OOC-17,012,734). Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02270-2.
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Affiliation(s)
- Fang Zhang
- Department of Anesthesiology, Peking University First Hospital, Xishiku Street No.8, 100034, Beijing, China
| | - Shu-Ting He
- Department of Anesthesiology, Peking University First Hospital, Xishiku Street No.8, 100034, Beijing, China
| | - Yan Zhang
- Department of Anesthesiology, Peking University First Hospital, Xishiku Street No.8, 100034, Beijing, China
| | - Dong-Liang Mu
- Department of Anesthesiology, Peking University First Hospital, Xishiku Street No.8, 100034, Beijing, China.
| | - Dong-Xin Wang
- Department of Anesthesiology, Peking University First Hospital, Xishiku Street No.8, 100034, Beijing, China
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Lin YJ, Lin LY, Peng YC, Zhang HR, Chen LW, Huang XZ, Chen Q. Association between glucose variability and postoperative delirium in acute aortic dissection patients: an observational study. J Cardiothorac Surg 2021; 16:82. [PMID: 33858463 PMCID: PMC8048274 DOI: 10.1186/s13019-021-01456-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 04/01/2021] [Indexed: 01/09/2023] Open
Abstract
Background Blood glucose variability is associated with poor prognosis after cardiac surgery, but the relationship between glucose variability and postoperative delirium in patients with acute aortic dissection is unclear. The study aims to investigate the association of blood glucose variability with postoperative delirium in acute aortic dissection patients. Methods We prospectively analyzed 257 patients including 103 patients with delirium. The patients were divided into two groups according to whether delirium was present. The outcome measures were postoperative delirium, the length of the Intensive Care Unit stay, and the duration of hospital stay. Multivariable Cox competing risk survival models was used to assess. Results A total of 257 subjects were enrolled, including 103 patients with delirium. There were statistically significant differences between the two groups in body mass index, history of cardiac surgery, first admission blood glucose, white blood cell counts, Acute Physiology and Chronic Health Evaluation II score, hypoxemia, mechanical ventilation duration, and the length of Intensive Care Unit stay(P < 0.05). The delirium group exhibited significantly higher values of the mean of blood glucose (MBG) and the standard deviation of blood glucose (SDBG) than in the non-delirium group(P < 0.05). In model 1, the adjusted hazard ratio (AHR) of the standard deviation of blood glucose was 1.436(P < 0.05). In Model 2, the standard deviation of blood glucose (AHR = 1.418, 95%CI = 1.195–1.681, P < 0.05) remained significant after adjusting for confounders. The area under the curve of the SDBG was 0.763(95%CI = 0.704–0.821, P < 0.01). The sensitivity was 81.6%, and the specificity was 57.8%. Conclusions Glucose variability is associated with the risk of delirium in patients after aortic dissection surgery, and high glycemic variability increases the risk of postoperative delirium.
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Affiliation(s)
- Yan-Juan Lin
- Department of Nursing, Union Hospital, Fujian Medical University, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China.
| | - Ling-Yu Lin
- Department of Nursing, Fujian Medical University, Fuzhou, China
| | - Yan-Chun Peng
- Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, 350001, Fujian, China
| | - Hao-Ruo Zhang
- Department of Clinical Medicine, Fujian Medical University, Fuzhou, China
| | - Liang-Wan Chen
- Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, 350001, Fujian, China.
| | - Xi-Zhen Huang
- Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, 350001, Fujian, China
| | - Qiong Chen
- Department of Nursing, Fujian Medical University, Fuzhou, China
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Mates E, Alluri D, Artis T, Riddle MS. A Retrospective Case Series of Thiamine Deficiency in Non-Alcoholic Hospitalized Veterans: An Important Cause of Delirium and Falling? J Clin Med 2021; 10:jcm10071449. [PMID: 33916273 PMCID: PMC8037750 DOI: 10.3390/jcm10071449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 03/22/2021] [Accepted: 03/24/2021] [Indexed: 12/19/2022] Open
Abstract
Thiamine deficiency (TD) in non-alcoholic hospitalized patients causes a variety of non-specific symptoms. Studies suggest it is not rare in acutely and chronically ill individuals in high income countries and is underdiagnosed. Our aim is to demonstrate data which help define the risk factors and constellation of symptoms of TD in this population. We describe 36 cases of TD in hospitalized non-alcoholic veterans over 5 years. Clinical and laboratory data were extracted by chart review +/− 4 weeks of plasma thiamine level 7 nmol/L or less. Ninety-seven percent had two or more chronic inflammatory conditions (CICs) and 83% had one or more acute inflammatory conditions (AICs). Of possible etiologies of TD 97% had two or more of: insufficient intake, inflammatory stress, or increased losses. Seventy-five percent experienced 5% or more weight loss. Ninety-two percent had symptoms with the most common being weakness or falling (75%) followed by neuropsychiatric manifestations (72%), gastrointestinal dysfunction (53%), and ataxia (42%). We conclude that TD is underdiagnosed in this population with consequent morbidity and mortality. TD likely develops because of inflammatory stress from CIC’s compounded by AIC’s combined with decreased energy intake or increased nutrient losses.
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Affiliation(s)
- Elisabeth Mates
- Medicine Department, Veterans Affairs Sierra Nevada Healthcare System, Reno, NV 89502, USA;
- School of Medicine, University of Nevada, Reno, NV 89502, USA;
- Correspondence:
| | - Deepti Alluri
- Sound Physicians, Lutheran Hospital, Fort Wayne, IN 46804, USA;
| | - Tailer Artis
- School of Medicine, University of Nevada, Reno, NV 89502, USA;
| | - Mark S. Riddle
- Medicine Department, Veterans Affairs Sierra Nevada Healthcare System, Reno, NV 89502, USA;
- School of Medicine, University of Nevada, Reno, NV 89502, USA;
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Liu H, Dai M, Guan H, Gao X, Zhou Y, Sun X, Zhou J, Hu X, Li X, Song Y, Han Y, Cao J. Preoperative Prognostic Nutritional Index Value is Related to Postoperative Delirium in Elderly Patients After Noncardiac Surgery: A Retrospective Cohort Study. Risk Manag Healthc Policy 2021; 14:1-8. [PMID: 33442311 PMCID: PMC7797345 DOI: 10.2147/rmhp.s280567] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 11/17/2020] [Indexed: 12/15/2022] Open
Abstract
Purpose Malnutrition has been considered as a risk factor for postoperative delirium (POD). The Prognostic Nutritional Index (PNI) is a validated tool for assessing nutritional status. This study aimed to investigate the association between preoperative PNI values and the occurrence of POD in elderly surgical patients. Methods The retrospective cohort study included 361 elderly individuals who underwent noncardiac surgery between 2018 and 2019. Perioperative data were collected from the patients’ medical records. PNI was used to evaluate preoperative nutritional status. The primary outcome was the occurrence of POD. Univariate and multivariate logistic regression analyses were used to identify key factors associated with POD and assess the relationship between PNI values and the occurrence of POD. Receiver operating characteristic (ROC) curve analysis was used to assess the predictive value of PNI for POD. Results Seventy-two (19.9%) individuals developed postoperative delirium after surgery. Compared with patients of normal nutrition status (PNI ≥ 50), mild malnutrition (PNI 45–50) did not increase the risk of POD, while patients with moderate to severe malnutrition (PNI 40–45) (odds ratio [OR], 2.92; 95% confidence interval [CI], 1.31–6.50) and serious malnutrition (PNI < 40) (OR, 3.15; 95% CI, 1.12–8.83) were more likely to develop POD. The cut-off value of PNI was 46.05 by ROC curve analysis, the area under the curve (AUC) was 0.69 (95% CI 0.62–0.77). Conclusion Preoperative PNI value is related to postoperative delirium in elderly patients after noncardiac surgery.
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Affiliation(s)
- He Liu
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou City 221002, Jiangsu Province, People's Republic of China.,Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou City 221004, Jiangsu Province, People's Republic of China
| | - Mingsheng Dai
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou City 221002, Jiangsu Province, People's Republic of China.,Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Huilian Guan
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou City 221002, Jiangsu Province, People's Republic of China
| | - Xing Gao
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou City 221002, Jiangsu Province, People's Republic of China
| | - Yang Zhou
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou City 221002, Jiangsu Province, People's Republic of China
| | - Xun Sun
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou City 221002, Jiangsu Province, People's Republic of China
| | - Jian Zhou
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou City 221002, Jiangsu Province, People's Republic of China
| | - Xiaoyi Hu
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou City 221002, Jiangsu Province, People's Republic of China
| | - Xiang Li
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou City 221002, Jiangsu Province, People's Republic of China
| | - Yu Song
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou City 221002, Jiangsu Province, People's Republic of China
| | - Yuan Han
- Department of Anesthesiology, Eye & ENT Hospital of Fudan University, Shanghai 20031, People's Republic of China
| | - Junli Cao
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou City 221002, Jiangsu Province, People's Republic of China.,Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou City 221004, Jiangsu Province, People's Republic of China
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Cobalamin Deficiency in the Elderly. Mediterr J Hematol Infect Dis 2020; 12:e2020043. [PMID: 32670521 PMCID: PMC7340236 DOI: 10.4084/mjhid.2020.043] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 05/30/2020] [Indexed: 12/16/2022] Open
Abstract
Older people are at risk for cobalamin (vitamin B12) deficiency because of a number of common disorders (e.g., autoimmune gastritis) and drugs (e.g., antacids) that may alter its absorption and utilization. The prevalence of cobalamin deficiency increases with age, resulting, particularly elevated, in frail and institutionalized subjects. At variance with common sense, the diagnosis is far from simple. It requires a high degree of suspicion, due to heterogeneity and non-specificity of the signs and symptoms, ranging from macrocytosis (with or without anemia) to neuropsychiatric manifestations, that characterize several other aging-related disorders, like hematological malignancies, diabetes, hypothyroidism or vasculopathy. Furthermore, the detection of low levels of serum vitamin B12 appears poorly sensitive and specific. Other biomarkers, like serum homocysteine or methylmalonic acid, have improved the diagnostic possibilities but are expensive, not widely available, and may be influenced by some confounders (e.g., folate deficiency, or chronic renal failure). Early recognition and treatment are crucial since a proportion of patients develop severe complications, such as bone marrow failure and irreversible neurological impairment. High-dose oral treatment has proven to be as effective as the parenteral route, even in subjects with malabsorption, ensuring the complete resolution in the majority of cases. In this review, we trace the essential role of cobalamin in humans, the possible causes and impact of deficiency, the diagnostic challenges and the therapeutic options, between old and emerging concepts, with a particular focus on the elderly.
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Correlation of Nutritional Indices on Admission to the Coronary Intensive Care Unit with the Development of Delirium. Nutrients 2018; 10:nu10111712. [PMID: 30413062 PMCID: PMC6267104 DOI: 10.3390/nu10111712] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 11/04/2018] [Accepted: 11/06/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Delirium is a common occurrence in patients admitted to the intensive care unit and is related to mortality and morbidity. Malnutrition is a predisposing factor for the development of delirium. Nevertheless, whether the nutritional status on admission anticipates the development of delirium in patients with acute cardiovascular diseases remains unknown. OBJECTIVE This study aims to assess the correlation between the nutritional status on admission using the nutritional index and the development of delirium in the coronary intensive care unit. DESIGN We examined 653 consecutive patients (mean age: 70 ± 14 years) admitted to the coronary intensive care unit of Juntendo University Hospital between January 2015 and December 2016. We evaluated three nutritional indices frequently used to assess the nutritional status, i.e., Geriatric Nutritional Risk Index (GNRI), Prognostic Nutritional Index (PNI), and Controlling Nutritional Status (CONUT). We defined delirium as patients with a delirium score >4 using the Intensive Care Delirium Screening Checklist. RESULTS Delirium was present in 58 patients. All nutritional indices exhibited a tendency for malnutrition in the delirium group compared with the non-delirium group (GNRI, 86.5 ± 9.38 versus 91.6 ± 9.89; PNI, 36.4 ± 6.95 versus 41.6 ± 7.62; CONUT, 5.88 ± 3.00 versus 3.61 ± 2.56; for all, p < 0.001). Furthermore, the maximum delirium score increased progressively from the low- to the high-risk group, as evaluated by each nutritional index (GNRI, PNI, CONUT; for all, p < 0.001). A multivariate analysis revealed that the PNI and CONUT were independent risk factors for the occurrence of delirium. CONCLUSIONS A marked correlation exists between the nutritional index on admission, especially PNI and CONUT, and the development of delirium in patients with acute cardiovascular diseases, suggesting that malnutrition assessment upon admission could help identify patients at high risk of developing delirium.
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Rosted E, Prokofieva T, Sanders S, Schultz M. Serious Consequences of Malnutrition and Delirium in Frail Older Patients. J Nutr Gerontol Geriatr 2018; 37:105-116. [PMID: 29792577 DOI: 10.1080/21551197.2018.1470055] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Malnutrition is highly prevalent in geriatric patients and is associated with an increased risk of death. In addition, delirium is a common condition of the older hospitalized patients. As brain has a high nutritional requirement, malnutrition may play an important role in cognitive dysfunction including the development of delirium. This study investigated the association between delirium and malnutrition in frail older patients and the effects on adverse outcomes. It was found that 75% of the patients with delirium suffered from malnutrition indicating that malnutrition contributes to the development of delirium in older hospitalized patients. Patients suffering from both malnutrition and delirium had a four times higher mortality in one month follow-up, a seven times increased rate of discharge to nursing homes and three days more in hospital. All older patients should routinely be assessed for malnutrition and delirium at admission to hospital and to prevent the development of delirium a close follow-up must take place to ensure adequate nutrition.
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Affiliation(s)
- Elizabeth Rosted
- a Department of Oncology and Palliative Care , Zealand University Hospital , Roskilde , Denmark
| | - Tatiana Prokofieva
- b Medical Department , Copenhagen University Hospital , Copenhagen , Denmark
| | - Suzanne Sanders
- b Medical Department , Copenhagen University Hospital , Copenhagen , Denmark
| | - Martin Schultz
- c Department of Internal Medicine and Geriatrics , University Hospital of Copenhagen , Herlev , Denmark
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Wang LK, Lan KM, Lin YT, Chen JY. Is cobalamin deficiency associated with increased risk of all subtypes of postoperative delirium? Neuropsychiatr Dis Treat 2016; 12:2029-31. [PMID: 27578975 PMCID: PMC4998022 DOI: 10.2147/ndt.s115296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Li-Kai Wang
- Department of Anesthesiology, Chi Mei Medical Center, Tainan
| | - Kuo-Mao Lan
- Department of Anesthesiology, Chi Mei Medical Center, Tainan; Department of Food Science and Applied Biotechnology, National Chung Hsing University, Taichung
| | - Yao-Tsung Lin
- Department of Anesthesiology, Chi Mei Medical Center, Tainan; Department of Food Science and Applied Biotechnology, National Chung Hsing University, Taichung
| | - Jen-Yin Chen
- Department of Anesthesiology, Chi Mei Medical Center, Tainan; Department of the Senior Citizen Service Management, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
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Sevuk U, Baysal E, Ay N, Altas Y, Altindag R, Yaylak B, Alp V, Demirtas E. Relationship between cobalamin deficiency and delirium in elderly patients undergoing cardiac surgery. Neuropsychiatr Dis Treat 2015; 11:2033-9. [PMID: 26300642 PMCID: PMC4535547 DOI: 10.2147/ndt.s87888] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Delirium is common after cardiac surgery and is independently associated with increased morbidity, mortality, prolonged hospital stays, and higher costs. Cobalamin (vitamin B12) deficiency is a common cause of neuropsychiatric symptoms and affects up to 40% of elderly people. The relationship between cobalamin deficiency and the occurrence of delirium after cardiac surgery has not been examined in previous studies. We examined the relationship between cobalamin deficiency and delirium in elderly patients undergoing coronary artery bypass grafting (CABG) surgery. MATERIAL AND METHODS A total of 100 patients with cobalamin deficiency undergoing CABG were enrolled in this retrospective study. Control group comprised 100 patients without cobalamin deficiency undergoing CABG. Patients aged 65 years or over were included. Diagnosis of delirium was made using Intensive Care Delirium Screening Checklist. Delirium severity was measured using the Delirium Rating Scale-revised-98. RESULTS Patients with cobalamin deficiency had a significantly higher incidence of delirium (42% vs 26%; P=0.017) and higher delirium severity scores (16.5±2.9 vs 15.03±2.48; P=0.034) than patients without cobalamin deficiency. Cobalamin levels were significantly lower in patients with delirium than patients without delirium (P=0.004). Delirium severity score showed a moderate correlation with cobalamin levels (ρ=-0.27; P=0.024). Logistic regression analysis demonstrated that cobalamin deficiency was independently associated with postoperative delirium (OR 1.93, 95% CI 1.03-3.6, P=0.038). CONCLUSION The results of our study suggest that cobalamin deficiency may be associated with increased risk of delirium in patients undergoing CABG. In addition, we found that preoperative cobalamin levels were associated with the severity of delirium. This report highlights the importance of investigation for cobalamin deficiency in patients undergoing cardiac surgery, especially in the elderly.
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Affiliation(s)
- Utkan Sevuk
- Department of Cardiovascular Surgery, Diyarbakir Gazi Yasargil Education and Research Hospital, Diyarbakir, Turkey
| | - Erkan Baysal
- Department of Cardiology, Diyarbakir Gazi Yasargil Education and Research Hospital, Diyarbakir, Turkey
| | - Nurettin Ay
- Department of General Surgery, Diyarbakir Gazi Yasargil Education and Research Hospital, Diyarbakir, Turkey
| | - Yakup Altas
- Department of Cardiology, Diyarbakir Gazi Yasargil Education and Research Hospital, Diyarbakir, Turkey
| | - Rojhat Altindag
- Department of Cardiology, Diyarbakir Gazi Yasargil Education and Research Hospital, Diyarbakir, Turkey
| | - Baris Yaylak
- Department of Cardiology, Diyarbakir Gazi Yasargil Education and Research Hospital, Diyarbakir, Turkey
| | - Vahhac Alp
- Department of General Surgery, Diyarbakir Gazi Yasargil Education and Research Hospital, Diyarbakir, Turkey
| | - Ertan Demirtas
- Department of Cardiovascular Surgery, Liv Hospital, Ankara, Turkey
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