Gender Differences and Postoperative Delirium in Adult Patients Undergoing Cardiac Valve Surgery

Background: Postoperative delirium (POD) is common in patients following cardiac surgery. According to studies on non-cardiac surgery, males suffered from higher incidence of POD. However, there is no report about effect of gender differences on POD occurrence in cardiac surgery patients. The aim of this study was to investigate the effect of gender differences on POD occurrence in adult patients after cardiac valve surgery.Methods: This is a retrospective case-control study. We recorded the clinical data in adult patients who underwent elective cardiac valve surgery from May 2019 to October 2020. POD was assessed by the Confusion Assessment Method for Intensive Care Unit. Univariate analysis was used to screen the potential risk factors. Collinearity analysis was conducted to detect overlapping predictor variables on the outcomes. A multivariate logistic regression with odds ratio (OR) and 95% confidence interval (CI) was used to identify the independent risk factors. The Hosmer-Lemeshow test was performed to show the good calibration of the logistic regression model.Results: In total, we recorded the perioperative data in 431 adult patients, including 212 males and 219 females. Sixty patients suffered from POD, including 39 males and 21 females. Twenty-one perioperative variables were selected, and 11 were screened by univariate analysis. We did not detect the severe collinearity among the 11 variables. Male gender was identified as a significant risk factor in POD occurrence in patients undergoing cardiac surgery (Adjusted OR: 2.213, 95% CI: 1.049–4.670, P = 0.037). The Hosmer-Lemeshow test demonstrated good calibration of the logistic regression model (χ2 = 7.238, P = 0.511). Besides, compared with females, the relationship of male and delirium subtypes was as follows: (1) hyperactive: adjusted OR: 3.384, 95% CI: 1.335–8.580, P = 0.010; (2) hypoactive: adjusted OR: 0.509, 95% CI: 0.147–1.766, P = 0.287. A Stratification analysis by age demonstrated that the males showed higher POD incidence in patients aged younger than 60 years (adjusted OR: 4.384, 95% CI: 1.318–14.586, P = 0.016).Conclusions: Male gender is an important risk factor in POD occurrence in patients following cardiac surgery. Furthermore, the incidence of hyperactive delirium is higher in males. Besides, the male patients aged younger than 60 years are at high risk of POD. We should pay more attention to the male patients to prevent their POD occurrence.

Download Full-text

Effect of intraoperative dexmedetomidine infusion on delirium in adult patients following cardiac valve surgery: a protocol of a randomized, double-blinded, and placebo-controlled study

Trials ◽

10.1186/s13063-020-04574-x ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Hong-Bai Wang ◽

Liang Zhang ◽

Zhe Zhang ◽

Su Yuan ◽

Fu-Xia Yan ◽

...

Keyword(s):

Valve Surgery ◽

Adult Patients ◽

Cardiac Valve ◽

Controlled Study ◽

Cardiac Valve Surgery ◽

Double Blinded ◽

Dexmedetomidine Infusion

Download Full-text

Prognostic Value of Pre-operative Plasma NT-proBNP Combined With Creatinine in Early Outcomes After Adult Cardiac Valve Surgery

10.21203/rs.3.rs-541308/v1 ◽

2021 ◽

Author(s):

Tianyuan Li ◽

Hanjun Cao ◽

Liangchao Qu ◽

Dingde Long ◽

Xiaoping Zhu

Keyword(s):

Logistic Regression ◽

Regression Model ◽

Prognostic Value ◽

Logistic Regression Model ◽

Valve Surgery ◽

Curve Analysis ◽

Cardiac Valve ◽

Plasma Creatinine ◽

Roc Curve Analysis ◽

Cardiac Valve Surgery

Abstract Objective To assess to prognostic value of pre-operative plasma NT-proBNP combined with creatinine in early outcomes after adult cardiac valve surgery. Methods A total of 125 patients who underwent cardiac valve surgery in the first affiliated hospital of nanchang university between October 2016 and October 2018 were retrospectively reviewed. including age, gender, weight, height, pre-operative plasma creatinine, preoperative plasma NT-proBNP, number of valves involved, pre-operative EF and early postoperative outcomes. The independent pre-operative factors that have a significant impact on early post-operative outcomes after adult cardiac valve surgery were investigated. Prognostic value in early outcomes after adult cardiac valve surgery was analyzed by ROC curve analysis. Results preoperative plasma creatinine, preoperative plasma NT-proBNP and the number of valves involved in the complication group were significantly higher than that in non-complication group;BMI and pre-operative EF in the complication group was lower than that in the non-complication group ,with a statistically significant difference(P<0.05). Factors having P-value < 0.15 in the bivariable logistic regression model were entered into a multivariable logistic regression model. The multivariate logistic regression analysis indicated that the preoperative plasma creatinine, preoperative plasma NT-proBNP,BMI and the number of valves involved were correlated with the early postoperative outcomes, and the differences were statistically significant (P < 0.05). ROC curve analysis was used to explore the predictive performance. Results in ROC curve analysis, the AUC for the preoperative plasma NT-proBNP was 0.806 (95% CI 0.712～0.900，P<0.00). Logistic regression model found that the predictive value increased after adding the pre-operative plasma creatinine.the joint prediction AUC was 0.843, the sensitivity and specificity were 85.0%, 72.4% respectively. Conclusion The elevated NT-proBNP and creatinine levels were independently correlated with the early post-operative outcomes, were two promising prognostic predictors for predicting the worse clinical outcomes . The pre-operative plasma NT-proBNP and the plasma creatinine combination was determined to help identify high-risk patients and make appropriate clinical decisions.

Download Full-text

The hidden link between plasma mitochondrial DNA level and cardiac dysfunction after cardiopulmonary bypass

10.21203/rs.3.rs-36879/v1 ◽

2020 ◽

Author(s):

Jing Xiu Fan ◽

Ling Zeng ◽

Lu Chen ◽

Ye Li ◽

Huqiong Pu ◽

...

Keyword(s):

Mitochondrial Dna ◽

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Cardiac Function ◽

Cardiac Dysfunction ◽

Heart Diseases ◽

Valve Surgery ◽

Cardiac Valve ◽

Apache Ii Score ◽

Cardiac Valve Surgery

Abstract Background: To investigate the hidden link between mitochondrial DNA (mtDNA) and cardiac function after cardiopulmonary bypass (CPB), we compared the relationship of plasma mtDNA level and the prevalence of cardiac dysfunction in patients receiving cardiac surgery with CPB.Methods: From September 1st, 2015 to December 1st, 2016, 962 patients who received cardiac surgery with CPB were prospectively comprised in this study. Routine blood test and examinations for blood biochemistry, NT-proBNP and mtDNA were arranged in half an hour when patients were transferred into intensive care unit (ICU). The clinical outcomes related to the cardiac function were determined by at least two senior doctors responsible for ICU. The data were inputted with double check and the inner logic of these data was set to establish the database. SAS 9.4, R 3.2.4 and SPSS 21.0 were used in data analysis.Results: Of the 962 patients (mean [SD] age, 51.6 [12.5] years; 459 [47.7%] male) comprised in this study, 692 patients received cardiac valve surgery, 83 patients received coronary artery bypass grafting (CABG), 58 patients received CABG and cardiac valve surgery at the same time, 70 patients received surgery on ascending aorta, 35 patients received surgery for simple congenital heart diseases and 15 patients received other types of surgery. The prevalence of cardiac dysfunction in this study is 9.25%. The level of mtRNA among patients with cardiac dysfunction and patients without cardiac dysfunction has no statistical significance (t=-1.42, P=0.1565). There was an obvious positive liner correlation between the level of plasma mtDNA and NT-proBNP in patients receiving CPB (r=0.1291, P=0.0386). There was an obvious positive liner correlation between the level of plasma mtDNA and APACHE II score in patients receiving CPB (r=0.2133, P<0.0001).Conclusions: The level of plasma mtDNA was closely related with the cardiac function and illness severity in patients receiving cardiac surgery with CPB.

Download Full-text