Diabetes and elevated preoperative HbA1c level as risk factors for postoperative delirium after cardiac surgery: an observational cohort study

Katarzyna Kotfis,1 Aleksandra Szylińska,2 Mariusz Listewnik,3 Mirosław Brykczyński,3 E Wesley Ely,4,5 Iwona Rotter21Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University, Szczecin, Poland; 2Department of Medical Rehabilitation and Clinical Physiothera...

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Autores principales:	Kotfis K, Szylińska A, Listewnik M, Brykczyński M, Ely EW, Rotter I
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2019
Materias:	delirium cardiac surgery diabetes glycated hemoglobin HbA1c glucose intolerance mortality outcome Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/1d807dd62c9e4e03a0d24d870c331c0a
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spelling	oai:doaj.org-article:1d807dd62c9e4e03a0d24d870c331c0a2021-12-02T09:10:56ZDiabetes and elevated preoperative HbA1c level as risk factors for postoperative delirium after cardiac surgery: an observational cohort study1178-2021https://doaj.org/article/1d807dd62c9e4e03a0d24d870c331c0a2019-02-01T00:00:00Zhttps://www.dovepress.com/diabetes-and-elevated-preoperative-hba1c-level-as-risk-factors-for-pos-peer-reviewed-article-NDThttps://doaj.org/toc/1178-2021Katarzyna Kotfis,1 Aleksandra Szylińska,2 Mariusz Listewnik,3 Mirosław Brykczyński,3 E Wesley Ely,4,5 Iwona Rotter21Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University, Szczecin, Poland; 2Department of Medical Rehabilitation and Clinical Physiotherapy, Pomeranian Medical University, Szczecin, Poland; 3Department of Cardiac Surgery, Pomeranian Medical University, Szczecin, Poland; 4Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; 5Geriatric Research, Education and Clinical Center (GRECC) Service, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN, USA Introduction: 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.Materials and methods: 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 Diagnostic Statistical Manual of Mental Disorders, fifth edition criteria.Results: 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%, P<0.001) and on oral diabetic medications (34.66% vs 24.07%, P<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%, P<0.001), but significance was reached only in nondiabetic patients (20.44% vs 14.86%, P=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, P<0.001), but only for patients on oral diabetic medications (OR: 1.617, 95% CI: 1.319–1.983, P<0.001) and an association was noted between HbA1c and POD (OR: 1.269, 95% CI: 1.161–1.387, P<0.001). Multivariate analysis controlled for diabetes showed that POD was associated with age, heart failure, preoperative creatinine, extracardiac arteriopathy, and preoperative HbA1c level.Conclusion: 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. Keywords: glycated hemoglobin, POD, mortality, outcome, ICUKotfis KSzylińska AListewnik MBrykczyński MEly EWRotter IDove Medical Pressarticledeliriumcardiac surgerydiabetesglycated hemoglobinHbA1cglucose intolerancemortalityoutcomeNeurosciences. Biological psychiatry. NeuropsychiatryRC321-571Neurology. Diseases of the nervous systemRC346-429ENNeuropsychiatric Disease and Treatment, Vol Volume 15, Pp 511-521 (2019)
institution	DOAJ
collection	DOAJ
language	EN
topic	delirium cardiac surgery diabetes glycated hemoglobin HbA1c glucose intolerance mortality outcome Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
spellingShingle	delirium cardiac surgery diabetes glycated hemoglobin HbA1c glucose intolerance mortality outcome Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429 Kotfis K Szylińska A Listewnik M Brykczyński M Ely EW Rotter I Diabetes and elevated preoperative HbA1c level as risk factors for postoperative delirium after cardiac surgery: an observational cohort study
description	Katarzyna Kotfis,1 Aleksandra Szylińska,2 Mariusz Listewnik,3 Mirosław Brykczyński,3 E Wesley Ely,4,5 Iwona Rotter21Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University, Szczecin, Poland; 2Department of Medical Rehabilitation and Clinical Physiotherapy, Pomeranian Medical University, Szczecin, Poland; 3Department of Cardiac Surgery, Pomeranian Medical University, Szczecin, Poland; 4Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; 5Geriatric Research, Education and Clinical Center (GRECC) Service, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN, USA Introduction: 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.Materials and methods: 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 Diagnostic Statistical Manual of Mental Disorders, fifth edition criteria.Results: 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%, P<0.001) and on oral diabetic medications (34.66% vs 24.07%, P<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%, P<0.001), but significance was reached only in nondiabetic patients (20.44% vs 14.86%, P=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, P<0.001), but only for patients on oral diabetic medications (OR: 1.617, 95% CI: 1.319–1.983, P<0.001) and an association was noted between HbA1c and POD (OR: 1.269, 95% CI: 1.161–1.387, P<0.001). Multivariate analysis controlled for diabetes showed that POD was associated with age, heart failure, preoperative creatinine, extracardiac arteriopathy, and preoperative HbA1c level.Conclusion: 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. Keywords: glycated hemoglobin, POD, mortality, outcome, ICU
format	article
author	Kotfis K Szylińska A Listewnik M Brykczyński M Ely EW Rotter I
author_facet	Kotfis K Szylińska A Listewnik M Brykczyński M Ely EW Rotter I
author_sort	Kotfis K
title	Diabetes and elevated preoperative HbA1c level as risk factors for postoperative delirium after cardiac surgery: an observational cohort study
title_short	Diabetes and elevated preoperative HbA1c level as risk factors for postoperative delirium after cardiac surgery: an observational cohort study
title_full	Diabetes and elevated preoperative HbA1c level as risk factors for postoperative delirium after cardiac surgery: an observational cohort study
title_fullStr	Diabetes and elevated preoperative HbA1c level as risk factors for postoperative delirium after cardiac surgery: an observational cohort study
title_full_unstemmed	Diabetes and elevated preoperative HbA1c level as risk factors for postoperative delirium after cardiac surgery: an observational cohort study
title_sort	diabetes and elevated preoperative hba1c level as risk factors for postoperative delirium after cardiac surgery: an observational cohort study
publisher	Dove Medical Press
publishDate	2019
url	https://doaj.org/article/1d807dd62c9e4e03a0d24d870c331c0a
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_version_	1718398170750255104

Diabetes and elevated preoperative HbA1c level as risk factors for postoperative delirium after cardiac surgery: an observational cohort study

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