Incidence of delirium in the critical care unit and risk factors in the Central Region, Saudi Arabia

Objectives:

To determine the incidence and risk factors of delirium in the cardiac care unit (CCU) and intensive care unit (ICU).

Methods:

This multicenter prospective observational study was conducted between July 2019 and November 2019 in the central region of Saudi Arabia. All patients admitted to the critical care units were enrolled, and their demographic data and risk factors of delirium were reported.

Results:

A total of 165 patients were included: 76 (46.1%) admitted to the CCU and 89 (53.9%) admitted to the ICU. The mean age was 55.1±18 years, and 45 (27.3%) were women. We found that 24/165 (14.5%) patients developed delirium during admission. Importantly, variables significantly associated with delirium group were female gender: (24.5% versus 10.8%, p=0.028), malnutrition (29.2% versus 5%, p<0.001), the presence of urinary catheter (75% versus 30.5%, p=0.001), septicemia (50% versus 14.9%, p<0.001), intubation (41.7% versus 10.6%, p=0.001), low hemoglobin (10.79±2.91 versus 12.05±2.77, p=048), and prolonged prothrombin time (PT) (15.87±5.17 versus 13.60±3.28, p=0.011).

Conclusion:

The incidence of delirium was 14.5% among patients admitted to critical care units in the central region of Saudi Arabia. Septicemia, prolonged PT, malnutrition, and urinary catheter are significant predictors of delirium.

AST/ALT ratio predicts the functional severity of chronic heart failure with reduced left ventricular ejection fraction

Objective

Despite previous research that focused on liver transaminases as predictors of cardiovascular disease, there has been limited research evaluating the predictive value of AST/ALT ratio in patients with heart failure. We aimed to investigate AST/ALT ratio as an indicator of the functional severity in chronic heart failure with reduced left ventricular ejection fraction.

Results

Overall, 105 patients previously diagnosed with HFrEF from Buraidah-Al Qassim province, Saudi Arabia were included in this retrospective cross-sectional study. Data on study variables, including demographic data, left ventricular ejection fraction, NYHA class, and AST/ALT ratio, were collected from patients’ records. The patients were divided into two groups, namely group-1 (AST/ALT ratio < 1) and group-2 (AST/ALT ratio ≥ 1), to identify any differences in their cardiac function profiles. NYHA class and NT-proBNP were higher and LVEF was lower in group-2 than in group-1. We found a mild significant correlation between AST/ALT ratio and APRI, FIB-4 score, NYHA-class, and LVEF (r = 0.2, 0.25, 0.26, and − 0.24, respectively; P < 0.05). Multivariate linear regression analysis model and ROC curve showed that AST/ALT ratio could independently predict HFrEF functional severity with a best cut-off value of 0.9, sensitivity of 43.6%, and specificity of 81.4%.

In-hospital mortality of acute coronary syndrome in elderly patients

Objectives:

To analyze predictors of death in elderly patients diagnosed with acute coronary syndrome (ACS).

Methods:

A record-based study carried out between January 2016 and January 2018 at The central province in Saudi Arabia. All elderly patients (>75 years) with definite diagnosis of ACS were retrospectively included. Demographic data, echocardiographic, and angiographic parameters were reported.

Results:

A total of 179 patients were enrolled, 129 (72%) were male. The mean age was 79±4.7 years. Approximately 102 (57%) patients were diagnosed with ST-segment elevation myocardial infarction (STEMI). Of all 125 (70%) underwent invasive coronary angiography, we found that 43 (24%) had significant single vessel disease (1VD), 29 (16.2%) had 2 vessel disease (2VD), and 41 (22.9%) had 3 vessel disease (3VD) or left main stenosis. During hospitalization 21 (11.7%) patients died, t-test analysis showed patients who died were significantly older (82±6.7 versus [vs.] 79±4.2 years, p=0.003). In addition we found that ejection fraction was lower in death group (30.2%±10.7) vs. (36.5%±1.1) in survivors, p=0.017); STEMI was more common in death group (90.5%) vs. (52.5%) in survivors, p=0.001); similarly, the prevalence of 3VD was higher in death group (38.1%) vs. (20.9%) in survivors, p=0.018). Importantly, PCI was not significantly different between death and survival groups (40% vs. 53.8%, p=0.177). A multivariate regression analysis demonstrated that predictors of death were: age (hazard ratio [HR], 1.214; 95% confidence interval [CI], 1.122-1.384; p<0.0001), intubation (HR, 10.106; 95% CI, 9.844-10.792; p<0.0001), and raised creatinine kinase-MB (CK-MB) (HR, 1.005; 95% CI, 1.002-1.013; p=0.04) predicted in hospital death.

Conclusion:

Older age, mechanical ventilation and raised CK-MB can significantly predict death in elderly patients (>75-year-old) diagnosed with ACS; nevertheless, PCI showed no survival benefits.