Department of Cardiac Sciences, University of Calgary, 8th Floor Cardiology, 1403 29th Street NW, Calgary, Alberta T2N-2T9, Canada.
Crit Care. 2010;14(5):R171. doi: 10.1186/cc9273. Epub 2010 Sep 27.
Delirium is the most common neurological complication following cardiac surgery. Much research has focused on potential causes of delirium; however, the sequelae of delirium have not been well investigated. The objective of this study was to investigate the relationship between delirium and sepsis post coronary artery bypass grafting (CABG) and to determine if delirium is a predictor of sepsis.
Peri-operative data were collected prospectively on all patients. Subjects were identified as having agitated delirium if they experienced a short-term mental disturbance marked by confusion, illusions and cerebral excitement. Patient characteristics were compared between those who became delirious and those who did not. The primary outcome of interest was post-operative sepsis. The association of delirium with sepsis was assessed by logistic regression, adjusting for differences in age, acuity, and co-morbidities.
Among 14,301 patients, 981 became delirious and 227 developed sepsis post-operatively. Rates of delirium increased over the years of the study from 4.8 to 8.0% (P = 0.0003). A total of 70 patients of the 227 with sepsis, were delirious. In 30.8% of patients delirium preceded the development of overt sepsis by at least 48 hours. Multivariate analysis identified several factors associated with sepsis, (receiver operating characteristic (ROC) 79.3%): delirium (odds ratio (OR) 2.3, 95% confidence interval (CI) 1.6 to 3.4), emergent surgery (OR 3.3, CI 2.2 to 5.1), age (OR 1.2, CI 1.0 to 1.3), pre-operative length of stay (LOS) more than seven days (OR 1.6, CI 1.1 to 2.3), pre-operative renal insufficiency (OR 1.9, CI 1.2 to 2.9) and complex coronary disease (OR 3.1, CI 1.8 to 5.3).
These data demonstrate an association between delirium and post-operative sepsis in the CABG population. Delirium emerged as an independent predictor of sepsis, along with traditional risk factors including age, pre-operative renal failure and peripheral vascular disease. Given the advancing age and increasing rates of delirium in the CABG population, the prevention and management of delirium need to be addressed.
谵妄是心脏手术后最常见的神经系统并发症。大量研究集中在谵妄的潜在病因上；然而，谵妄的后遗症尚未得到充分研究。本研究的目的是探讨心脏搭桥术后（CABG）谵妄与脓毒症的关系，并确定谵妄是否是脓毒症的预测因素。
前瞻性收集所有患者的围手术期数据。如果患者出现短期精神障碍，表现为意识混乱、幻觉和大脑兴奋，则确定为躁动性谵妄。比较出现谵妄和未出现谵妄的患者的特征。主要观察终点为术后脓毒症。采用 logistic 回归分析评估谵妄与脓毒症的相关性，调整年龄、疾病严重程度和合并症的差异。
在 14301 名患者中，981 名出现谵妄，227 名术后发生脓毒症。研究期间，谵妄发生率从 4.8%上升至 8.0%（P=0.0003）。227 名脓毒症患者中，有 70 名出现谵妄。在 30.8%的患者中，谵妄至少在显性脓毒症发生前提前出现了 48 小时。多变量分析确定了与脓毒症相关的几个因素（受试者工作特征（ROC）为 79.3%）：谵妄（比值比（OR）2.3，95%置信区间（CI）1.6 至 3.4），急诊手术（OR 3.3，CI 2.2 至 5.1），年龄（OR 1.2，CI 1.0 至 1.3），术前住院时间超过 7 天（OR 1.6，CI 1.1 至 2.3），术前肾功能不全（OR 1.9，CI 1.2 至 2.9）和复杂的冠状动脉疾病（OR 3.1，CI 1.8 至 5.3）。
这些数据表明，CABG 人群中谵妄与术后脓毒症之间存在关联。谵妄是脓毒症的独立预测因素，与年龄、术前肾功能衰竭和外周血管疾病等传统危险因素一起。鉴于 CABG 人群的年龄不断增加和谵妄发生率的不断增加，需要解决谵妄的预防和管理问题。
