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Cardiac Delirium Index for Predicting the Occurrence of Postoperative Delirium in Adult Patients After Coronary Artery Bypass Grafting

Authors Lechowicz K, Szylińska A, Listewnik M, Drożdżal S, Tomska N, Rotter I, Kotfis K

Received 18 January 2021

Accepted for publication 26 February 2021

Published 17 March 2021 Volume 2021:16 Pages 487—495


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Professor Nandu Goswami

Kacper Lechowicz,1 Aleksandra Szylińska,2 Mariusz Listewnik,3 Sylwester Drożdżal,4 Natalia Tomska,2 Iwona Rotter,2 Katarzyna Kotfis1

1Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University in Szczecin, Szczecin, 70-111, Poland; 2Department of Medical Rehabilitation and Clinical Physiotherapy, Pomeranian Medical University in Szczecin, Szczecin, 71-210, Poland; 3Department of Cardiac Surgery, Pomeranian Medical University in Szczecin, Szczecin, 70-111, Poland; 4Department of Pharmacokinetics and Monitored Therapy, Pomeranian Medical University, Szczecin, 70-111, Poland

Correspondence: Katarzyna Kotfis
Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University in Szczecin, Al. Powstańców Wielkopolskich 72, Szczecin, 70-111, Poland
Tel +48 91-466-11-44
Email [email protected]

Background: Postoperative delirium (POD) is a serious complication of cardiac surgery. It is an acute neuropsychiatric syndrome. The aim of this study was to analyze the CARDEL Index, composed of advancing age, preoperative glycated hemoglobin and the platelet-to-WBC ratio (PWR) previously described and calculated, using a different patient database, to assess its usefulness as a marker for predicting postoperative delirium after coronary artery by-pass grafting (CABG).
Methods: A retrospective analysis of 1098 patients who underwent, isolated CABG procedures between 2017 and 2019 was performed.
Results: Within the study group, 164/1098 (14.93%) patients were diagnosed with delirium. Preoperative inflammatory parameters were elevated in patients with delirium: White Blood Cell count (p=0.003), Neutrophil count (p=0.016) and C-reactive protein (p< 0.001). A decrease in preoperative PWR was shown in patients with delirium (p=0.008). Delirious patients spent more time mechanically ventilated (p< 0.001) and had longer hospitalization times (p=0.002). Mortality at 1 year was significantly higher in patients with POD (p< 0.001). The CARDEL Index in this study group for POD detection has the largest area under the curve (AUC) of 0.664 (p< 0.001) and a cut-off value of 8.08.
Conclusion: CARDEL Index may be treated as a potentially valuable tool for delirium prediction in patients after CABG.

Keywords: delirium, POD, CAM-ICU, cardiac surgery, CABG, coronary artery bypass grafting

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