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Critical Care
Published in: Critical Care 2/2013

Open Access 01-04-2013 | Research

Cortisol levels and neuropsychiatric diagnosis as markers of postoperative delirium:a prospective cohort study

Authors: Jakub Kazmierski, Andrzej Banys, Joanna Latek, Julius Bourke, Ryszard Jaszewski

Published in: Critical Care | Issue 2/2013

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Abstract

Introduction

The pathophysiology of delirium after cardiac surgery is largely unknown. Thepurpose of this study was to investigate whether increased concentration ofpreoperative and postoperative plasma cortisol predicts the development ofdelirium after coronary artery bypass graft surgery. A second aim was to assesswhether the association between cortisol and delirium is stress related ormediated by other pathologies, such as major depressive disorder (MDD) orcognitive impairment.

Methods

The patients were examined 1 day preoperatively with the Mini InternationalNeuropsychiatric Interview and the Montreal Cognitive Assessment and the TrailMaking Test to screen for depression and for cognitive impairment, respectively.Blood samples for cortisol levels were collected both preoperatively andpostoperatively. The Confusion Assessment Method for the Intensive Care Unit wasused within the first 5 days postoperatively to screen for a diagnosis ofdelirium.

Results

Postoperative delirium developed in 36% (41 of 113) of participants. Multivariatelogistic regression analysis revealed two groups independently associated with anincreased risk of developing delirium: those with preoperatively raised cortisollevels; and those with a preoperative diagnosis of MDD associated with raisedlevels of cortisol postoperatively. According to receiver operating characteristicanalysis, the most optimal cutoff values of the preoperative and postoperativecortisol concentration that predict the development of delirium were 353.55 nmol/land 994.10 nmol/l, respectively.

Conclusion

Raised perioperative plasma cortisol concentrations are associated with deliriumafter coronary artery bypass graft surgery. This may be an importantpathophysiological consideration in the increased risk of postoperative deliriumseen in patients with a preoperative diagnosis of MDD.
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Metadata
Title
Cortisol levels and neuropsychiatric diagnosis as markers of postoperative delirium:a prospective cohort study
Authors
Jakub Kazmierski
Andrzej Banys
Joanna Latek
Julius Bourke
Ryszard Jaszewski
Publication date
01-04-2013
Publisher
BioMed Central
Published in
Critical Care / Issue 2/2013
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc12548

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