Cortisol levels and neuropsychiatric diagnosis as markers of postoperative delirium: a prospective cohort study.
Cortisol levels and neuropsychiatric diagnosis as markers of postoperative delirium: a prospective cohort study.
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DOI：
10.1186/cc12548
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发表时间：
2013-03-01
期刊：
影响因子：
--
通讯作者：
Jaszewski R
中科院分区：
文献类型：
--
作者：
Kazmierski J;Banys A;Latek J;Bourke J;Jaszewski R
心脏手术后谵妄的病理生理机制在很大程度上是未知的。本研究的目的是探讨术前和术后血浆皮质醇浓度的增加是否预示着冠状动脉旁路移植术后谵妄的发生。第二个目的是评估皮质醇和谵妄之间的关联是否与压力有关或由其他病理学介导，如重度抑郁症（MDD）或认知障碍。术前1天，患者接受了简易国际神经精神访谈、蒙特利尔认知评估和连线测验，分别筛查抑郁和认知障碍。在术前和术后采集用于皮质醇水平的血液样本。在术后前5天内使用重症监护室的意识模糊评估方法筛选谵妄诊断。36%（41/113）的参与者发生术后谵妄。多变量logistic回归分析显示，两组独立与发展谵妄的风险增加相关：术前皮质醇水平升高的患者;以及术前诊断为MDD且术后皮质醇水平升高的患者。根据受试者操作特征分析，术前和术后皮质醇浓度预测谵妄发生的最佳临界值分别为353.55 nmol/L和994.10 nmol/L。冠状动脉旁路移植术后围手术期血浆皮质醇浓度升高与谵妄相关。这可能是术前诊断为MDD的患者术后谵妄风险增加的重要病理生理学考虑因素。
The pathophysiology of delirium after cardiac surgery is largely unknown. The purpose of this study was to investigate whether increased concentration of preoperative and postoperative plasma cortisol predicts the development of delirium after coronary artery bypass graft surgery. A second aim was to assess whether the association between cortisol and delirium is stress related or mediated by other pathologies, such as major depressive disorder (MDD) or cognitive impairment. The patients were examined 1 day preoperatively with the Mini International Neuropsychiatric Interview and the Montreal Cognitive Assessment and the Trail Making Test to screen for depression and for cognitive impairment, respectively. Blood samples for cortisol levels were collected both preoperatively and postoperatively. The Confusion Assessment Method for the Intensive Care Unit was used within the first 5 days postoperatively to screen for a diagnosis of delirium. Postoperative delirium developed in 36% (41 of 113) of participants. Multivariate logistic regression analysis revealed two groups independently associated with an increased risk of developing delirium: those with preoperatively raised cortisol levels; and those with a preoperative diagnosis of MDD associated with raised levels of cortisol postoperatively. According to receiver operating characteristic analysis, the most optimal cutoff values of the preoperative and postoperative cortisol concentration that predict the development of delirium were 353.55 nmol/l and 994.10 nmol/l, respectively. Raised perioperative plasma cortisol concentrations are associated with delirium after coronary artery bypass graft surgery. This may be an important pathophysiological consideration in the increased risk of postoperative delirium seen in patients with a preoperative diagnosis of MDD.
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影响因子：
2.1
作者：
Peavy GM;Jacobson MW;Salmon DP;Gamst AC;Patterson TL;Goldman S;Mills PJ;Khandrika S;Galasko D
通讯作者：
Galasko D
影响因子：
8.8
作者：
Ely, EW;Margolin, R;Inouye, SK
通讯作者：
Inouye, SK
影响因子：
4.7
作者：
Kazmierski, Jakub;Kowman, Maciej;Kloszewska, Iwona
通讯作者：
Kloszewska, Iwona
影响因子：
5
作者：
Murray, Fraser;Smith, David W.;Hutson, Peter H.
通讯作者：
Hutson, Peter H.
影响因子：
5.3
作者：
Sheehan, DV;Lecrubier, Y;Dunbar, GC
通讯作者：
Dunbar, GC