High serum cortisol level is associated with increased risk of delirium after coronary artery bypass graft surgery: a prospective cohort study

Dong-Liang Mu, Dong-Xin Wang, Li-Huan Li, Guo-Jin Shan, Jun Li, Qin-Jun Yu, Chun-Xia Shi, Dong-Liang Mu, Dong-Xin Wang, Li-Huan Li, Guo-Jin Shan, Jun Li, Qin-Jun Yu, Chun-Xia Shi

Abstract

Introduction: The pathophysiology of postoperative delirium remains poorly understood. The purpose of this study was to examine the relationship between serum cortisol level and occurrence of early postoperative delirium in patients undergoing coronary artery bypass graft (CABG) surgery.

Methods: A total of 243 patients undergoing elective CABG surgery were enrolled. Patients were examined twice daily during the first five postoperative days and postoperative delirium was diagnosed by using the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Blood samples were obtained between 7 a.m. and 8 a.m. on the first postoperative day and serum cortisol concentrations were then measured. Multivariate logistic regression analyses were performed to identify risk factors of postoperative delirium.

Results: Postoperative delirium occurred in 50.6% (123 of 243) of patients. High serum cortisol level was significantly associated with increased risk of postoperative delirium (OR 3.091, 95% CI 1.763-5.418, P < 0.001). Other independent risk factors of postoperative delirium included increasing age (OR 1.111, 95% CI 1.065-1.159, P < 0.001), history of diabetes mellitus (OR 1.905, 95% CI 1.001-3.622, P = 0.049), prolonged duration of surgery (OR 1.360, 95% CI 1.010-1.831, P = 0.043), and occurrence of complications within the first day after surgery (OR 2.485, 95% CI 1.184-5.214, P = 0.016). Patients who developed postoperative delirium had a higher incidence of postoperative complications and a prolonged duration of postoperative ICU and hospital stay.

Conclusions: Delirium was a common complication after CABG surgery. High serum cortisol level was associated with increased risk of postoperative delirium. Patients who developed delirium had outcomes worse than those who did not.

Figures

Figure 1
Figure 1
Flow diagram of the study. LVEF, left ventricular ejection fraction.
Figure 2
Figure 2
Number of patients whose first episode of delirious symptoms occurred during the postoperative period. Note that in 97.6% of the delirious cases (120 of 123), the initial symptom occurred within the first three days after surgery. POD, postoperative delirium.
Figure 3
Figure 3
Relationship between serum cortisol level and incidence of postoperative delirium (POD) after coronary artery bypass graft surgery. Patients with a higher serum cortisol level had a significantly higher incidence of POD (P < 0.001). Level 1 indicates a serum cortisol concentration of less than 138 nmol/L, level 2 indicates a serum cortisol concentration of between 138 and 690 nmol/L, and level 3 indicates a serum cortisol concentration of greater than 690 nmol/L.

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