Faculty of Medicine, Department of Cardiology, Baskent University, Adana 01250, Turkey.
Am J Emerg Med. 2013 Jan;31(1):161-5. doi: 10.1016/j.ajem.2012.07.001. Epub 2012 Aug 20.
Delirium can be associated with cardiac system disorders. Stress plays an important role in the pathogenesis of postoperative delirium. Cortisol is one of the most important stress hormones in humans. We aimed to investigate whether a relation exists between serum cortisol and the degree of delirium after acute coronary syndromes (ACS).
We enrolled 52 consecutive patients who presented with ACS and were hospitalized in the coronary care unit. Patients were examined daily by a single psychiatrist, and delirium was diagnosed by using the Delirium Rating Scale (DSR). Blood samples were obtained at 6:00 am of the next morning after admission.
The mean age was 66 years (SD, ±6 years), and 52% were men. Delirium occurred in 25 patients (48%). The median score on the DRS was 17 for the delirious patients and 5 for the nondelirious. Median cortisol levels were significantly different between the delirium and nondelirium groups (13.9 vs 6.2 μg/dL; P < .01). There were significant correlations between the cortisol levels and the severity of the delirium based on DRS scores as well as between the cortisol levels and the presence of delirium (r = 0.65 and 0.74, respectively; P = .01). In a linear logistic regression model, cortisol predicted the occurrence of delirium (β = .81; P < .01). In receiver operating characteristics analysis, the optimal cutoff value of cortisol to predict delirium was 10.8 μg/dL, with 96% sensitivity and 89% specificity.
Delirium was common after ACS, and serum cortisol levels correlated with the degree of delirium and the risk of delirium.
谵妄可与心脏系统紊乱相关。应激在术后谵妄的发病机制中起着重要作用。皮质醇是人类最重要的应激激素之一。我们旨在研究急性冠状动脉综合征（ACS）后血清皮质醇与谵妄程度之间是否存在关系。
我们纳入了 52 例连续出现 ACS 并住院于冠心病监护病房的患者。每天由一名精神科医生对患者进行检查，使用谵妄评定量表（DRS）诊断谵妄。入院次日早上 6 点采集血样。
患者平均年龄为 66 岁（标准差，±6 岁），52%为男性。25 例患者（48%）发生谵妄。谵妄患者的 DRS 中位数评分为 17 分，非谵妄患者为 5 分。谵妄组和非谵妄组的皮质醇中位数水平差异有统计学意义（13.9 与 6.2μg/dL；P＜.01）。皮质醇水平与 DRS 评分所示的谵妄严重程度之间存在显著相关性，与谵妄的存在之间也存在显著相关性（r 值分别为 0.65 和 0.74；P=.01）。在线性逻辑回归模型中，皮质醇预测谵妄的发生（β=0.81；P＜.01）。在受试者工作特征分析中，预测谵妄的皮质醇最佳截断值为 10.8μg/dL，具有 96%的敏感性和 89%的特异性。
ACS 后谵妄常见，血清皮质醇水平与谵妄程度和谵妄风险相关。
