Hong Liang, Shen Xiao, Shi Qiankun, Song Xiaochun, Chen Lihai, Chen Wenxiu, Chen Shangyu, Xue Yingyin, Zhang Cui, Zhou Jifang
Department of Intensive Care Unit, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
Department of Anesthesia, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
Front Cardiovasc Med. 2022 Mar 8;9:828015. doi: 10.3389/fcvm.2022.828015. eCollection 2022.
The association between hypernatremia and delirium after cardiac surgery has rarely been investigated. This study aimed to determine whether hypernatremia increases the risk of delirium after exposure.
From April 2016 to June 2021, 7,831 consecutive patients receiving cardiac surgery were screened for potential enrollment. The primary outcome was postoperative delirium (POD). For the respective case of delirium, 10 controls were matched according to the index date within the nested case-control design. Hypernatremia exposure was defined as serum sodium > 145 mmol/L within 7 days before the index date. A generalized estimation equation was performed to assess excess risks for POD associated with hypernatremia, adjusted for demographics and clinical variables.
About 7,277 patients were included in the final analyses. About 669 (9.2%) patients with POD were assigned to the case group, and 6,690 controls were identified from the whole population. About 66.5% of the cases and 36.3% of the controls had hypernatremia exposure. After being adjusted to certain well-recognized confounding factors, hypernatremia showed a significant correlation with increased risk of delirium after cardiac surgery (adjusted OR, 1.73; 95% CI, 1.41~2.12). An e-value analysis suggested the robustness to unmeasured confounding.
Hypernatremia was associated with an increased risk of delirium after cardiac surgery. This finding could have implications for risk stratification, early detection, and management of delirium in patients receiving cardiac surgery.
心脏手术后高钠血症与谵妄之间的关联鲜有研究。本研究旨在确定高钠血症是否会增加术后谵妄的风险。
2016年4月至2021年6月，对7831例连续接受心脏手术的患者进行潜在入选筛查。主要结局是术后谵妄（POD）。在巢式病例对照设计中，对于每例谵妄病例，根据索引日期匹配10名对照。高钠血症暴露定义为索引日期前7天内血清钠>145 mmol/L。采用广义估计方程评估与高钠血症相关的POD额外风险，并对人口统计学和临床变量进行校正。
最终纳入分析约7277例患者。约669例（9.2%）发生POD的患者被分配到病例组，从总体人群中确定了6690名对照。约66.5%的病例和36.3%的对照有高钠血症暴露。在调整了某些公认的混杂因素后，高钠血症与心脏手术后谵妄风险增加显著相关（校正OR，1.73；95%CI，1.41~2.12）。e值分析表明对未测量的混杂因素具有稳健性。
高钠血症与心脏手术后谵妄风险增加相关。这一发现可能对心脏手术患者谵妄的风险分层、早期检测和管理具有重要意义。
