The relationship between serum cobalamin, folic acid, and homocysteine and the risk of post-cardiac surgery delirium
Received 15 January 2019
Accepted for publication 25 March 2019
Published 23 May 2019 Volume 2019:15 Pages 1413—1419
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 2
Editor who approved publication: Dr Roger Pinder
Maryam Vahdat Shariatpanahi,1 Aynaz Velayati,2 Seyed Ali Jamalian,3 Mehdi Babevaynejad,4 Zahra Vahdat Shariatpanahi2
1Department of Psychiatry, Faculty of Medicine, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran; 2National Nutrition and Food Technology Research Institute, Faculty of Nutrition and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran; 3Department of Cardiology, Shahid Lavasani Hospital, Islamic Azad University, Tehran, Iran; 4Department of Cardiac Surgery, Shahid Lavasani Hospital, Islamic Azad University, Tehran, Iran
Purpose: It has been reported that cobalamin and folate deficiency is related to delirium in persons with dementia. We evaluated the association of admission serum levels of cobalamin, folic acid, and homocysteine with the occurrence of acute delirium after coronary artery bypass surgery.
Methods: In this prospective cohort study, serum levels of cobalamin, folic acid, and homocysteine were measured for 296 patients upon admission. Delirium was defined by the confusion assessment method for the intensive care unit.
Results: Postoperative delirium was detected in 23% (n=68) of patients. Cobalamin deficiency, folate deficiency, and hyperhomocysteinemia were observed in 29% (n=86), 6% (n=18), and 68% (n=200) of patients, respectively. The mean ± SD serum levels of folic acid were 10.77±5.39 ng/mL and 12.86±6.51 ng/mL in delirium and non-delirium patients, respectively (P=0.008). The median (interquartile range [IQR]) serum levels of cobalamin were 280 (216–351) and 247 (195.5–336) in delirium and non-delirium patients, respectively (P=0.09). The median (IQR) serum levels of homocysteine were 18.5 (14.5–22.1) μmol/L and 17.33 (14.2–23.2) μmol/L in delirium and non-delirium patients, respectively (P=0.94). Multivariate regression analysis adjusted by other risk factors indicated that serum homocysteine, folate, and cobalamin levels had no association with the occurrence of delirium.
Conclusion: There was no relationship between the preoperative levels of cobalamin, folate, and homocysteine, and acute occurrence of delirium observed after cardiac surgery.
Keywords: vitamin B12, CAM-ICU, cardiopulmonary bypass, intensive care unit
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