Kotfis Katarzyna, Szylińska Aleksandra, Listewnik Mariusz, Brykczyński Mirosław, Ely E Wesley, Rotter Iwona
Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University, Szczecin, Poland.
Department of Medical Rehabilitation and Clinical Physiotherapy, Pomeranian Medical University, Szczecin, Poland,
Neuropsychiatr Dis Treat. 2019 Feb 20;15:511-521. doi: 10.2147/NDT.S196973. eCollection 2019.
Postoperative delirium (POD) is a common complication of cardiac surgery associated with increased mortality, morbidity, and long-term cognitive dysfunction. Diabetic patients, especially those with poor diabetes control and long-standing hyperglycemia, may be at risk of developing delirium. The aim of this study was to analyze whether the occurrence of POD in cardiac surgery is associated with diabetes or elevated preoperative glycated hemoglobin (HbA1c) level.
We performed a cohort analysis of prospectively collected data from a register of cardiac surgery department of a university hospital. Delirium assessment was performed twice a day during the first 5 days after the operation based on , fifth edition criteria.
We analyzed a cohort of 3,178 consecutive patients, out of which 1,010 (31.8%) were diabetic and 502 (15.8%) were diagnosed with POD. Patients with delirium were more often diabetic (42.03% vs 29.86%, <0.001) and on oral diabetic medications (34.66% vs 24.07%, <0.001), no difference was found in patients with insulin treatment. Preoperative HbA1c was elevated above normal (≥6%) in more delirious than nondelirious patients (44.54% vs 33.04%, <0.001), but significance was reached only in nondiabetic patients (20.44% vs 14.86%, =0.018). In univariate analysis, the diagnosis of diabetes was associated with an increased risk of developing POD (OR: 1.703, 95% CI: 1.401-2.071, <0.001), but only for patients on oral diabetic medications (OR: 1.617, 95% CI: 1.319-1.983, <0.001) and an association was noted between HbA1c and POD (OR: 1.269, 95% CI: 1.161-1.387, <0.001). Multivariate analysis controlled for diabetes showed that POD was associated with age, heart failure, preoperative creatinine, extracardiac arteriopathy, and preoperative HbA1c level.
More diabetic patients develop POD after cardiac surgery than nondiabetic patients. Elevated preoperative HbA1c level is a risk factor for postcardiac surgery delirium regardless of the diagnosis of diabetes.
术后谵妄（POD）是心脏手术常见的并发症，与死亡率、发病率增加以及长期认知功能障碍相关。糖尿病患者，尤其是那些糖尿病控制不佳且长期存在高血糖的患者，可能有发生谵妄的风险。本研究的目的是分析心脏手术中POD的发生是否与糖尿病或术前糖化血红蛋白（HbA1c）水平升高有关。
我们对一所大学医院心脏外科登记处前瞻性收集的数据进行了队列分析。术后前5天每天根据第五版标准进行两次谵妄评估。
我们分析了连续3178例患者的队列，其中1010例（31.8%）为糖尿病患者，502例（15.8%）被诊断为POD。谵妄患者中糖尿病患者更多见（42.03%对29.86%，<0.001）且使用口服降糖药的比例更高（34.66%对24.07%，<0.001），胰岛素治疗患者中未发现差异。术前HbA1c高于正常水平（≥6%）的谵妄患者比非谵妄患者更多（44.54%对33.04%，<0.001），但仅在非糖尿病患者中具有统计学意义（20.44%对14.86%，=0.018）。在单因素分析中，糖尿病诊断与发生POD的风险增加相关（OR：1.703，95%CI：1.401 - 2.071，<0.001），但仅适用于使用口服降糖药的患者（OR：1.617，95%CI：1.319 - 1.983，<0.001），并且HbA1c与POD之间存在关联（OR：1.269，95%CI：1.161 - 1.387，<0.001）。对糖尿病进行校正的多因素分析显示，POD与年龄、心力衰竭、术前肌酐、心外动脉病变以及术前HbA1c水平相关。
心脏手术后发生POD的糖尿病患者比非糖尿病患者更多。术前HbA1c水平升高是心脏手术后谵妄的危险因素，与糖尿病诊断无关。
