Hypernatremia increases the incidence of late delirium after cardiac surgery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

HONG Liang , SHEN Xiao , SHU Chang , SHI Qiankun , MU Xinwei ,  ZHANG Cui

Department of Intensive Care Unit, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, P.R.China;

Corresponding author：

ZHANG Cui, Email: 18951670283@163.com

Keywords：

Cardiac surgery; hypernatremia; postoperative delirium

DOI：

10.7507/1007-4848.202004075

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To analyze whether hypernatremia within 48 hours after cardiac surgery will increase the incidence of delirium which developed 48 hours later after surgery (late-onset delirium).Methods We conducted a retrospective analysis of 3 365 patients, including 1 918 males and 1 447 females, aged 18-94 ( 60.53±11.50) years, who were admitted to the Department of Cardiothoracic and Vascular Surgery of Nanjing First Hospital and underwent cardiac surgery from May 2016 to May 2019.Results A total of 155 patients developed late-onset delirium, accounting for 4.61%. The incidence of late-onset delirium in patients with hypernatremia was 9.77%, the incidence of late onset delirium in patients without hypernatremia was 3.45%, and the difference was statistically different (P<0.001). The odds ratio (OR) of hypernatremia was 3.028 (95% confidence interval: 2.155-4.224, P<0.001). The OR adjusted for other risk factors including elderly patients, previous history of cerebrovascular disease, operation time, cardiopulmonary bypass time, lactate, hemoglobin≥100 g/L, prolonged mechanical ventilation, left ventricular systolic function, use of epinephrine, use of norepinephrine was 1.524 (95% confidence interval: 1.031-2.231, P=0.032).Conclusion Hypernatremia within 48 hours after cardiac surgery may increase the risk of delirium in later stages.

Citation： HONG Liang, SHEN Xiao, SHU Chang, SHI Qiankun, MU Xinwei, ZHANG Cui. Hypernatremia increases the incidence of late delirium after cardiac surgery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(11): 1320-1325. doi: 10.7507/1007-4848.202004075 Copy

1.	Smulter N, Lingehall HC, Gustafson Y, et al. Delirium after cardiac surgery: Incidence and risk factors. Interact Cardiovasc Thorac Surg, 2013, 17(5): 790-796.
2.	Bucerius J, Gummert JF, Borger MA, et al. Predictors of delirium after cardiac surgery delirium: Effect of beating-heart (off-pump) surgery. J Thorac Cardiovasc Surg, 2004, 127(1): 57-64.
3.	Eriksson M, Samuelsson E, Gustafson Y, et al. Delirium after coronary bypass surgery evaluated by the organic brain syndrome protocol. Scand Cardiovasc J, 2002, 36(4): 250-255.
4.	Rudolph JL, Jones RN, Levkoff SE, et al. Derivation and validation of a preoperative prediction rule for delirium after cardiac surgery. Circulation, 2009, 119(2): 229-236.
5.	Crocker E, Beggs T, Hassan A, et al. Long-term effects of postoperative delirium in patients undergoing cardiac operation: a systematic review. Ann Thorac Surg, 2016, 102(4): 1391-1399.
6.	Hollinger A, Siegemund M, Goettel N, et al. Postoperative delirium in cardiac surgery: An unavoidable menace? J Cardiothorac Vasc Anesth, 2015, 29(6): 1677-1687.
7.	Falsini G, Grotti S, Porto I, et al. Long-term prognostic value of delirium in elderly patients with acute cardiac diseases admitted to two cardiac intensive care units: a prospective study (DELIRIUM CORDIS). Eur Heart J Acute Cardiovasc Care, 2017, 7(7): 661-670.
8.	Hirsch J, DePalma G, Tsai TT, et al. Impact of intraoperative hypotension and blood pressure fluctuations on early postoperative delirium after non-cardiac surgery. Br J Anaesth, 2015, 115(3): 418-426.
9.	Plaschke K, Fichtenkamm P, Schramm C, et al. Early postoperative delirium after open-heart cardiac surgery is associated with decreased bispectral EEG and increased cortisol and interleukin-6. Intensive Care Med, 2010, 36(12): 2081-2089.
10.	Stelfox HT, Ahmed SB, Zygun D, et al. Characterization of intensive care unit acquired hyponatremia and hypernatremia following cardiac surgery. Can J Anaesth, Springer, 2010, 57(7): 650-658.
11.	Lindner G, Funk GC, Lassnigg A, et al. Intensive care-acquired hypernatremia after major cardiothoracic surgery is associated with increased mortality. Intensive Care Med, 2010, 36(10): 1718-1723.
12.	Cecconi M, Hochrieser H, Chew M, et al. Preoperative abnormalities in serum sodium concentrations are associated with higher in-hospital mortality in patients undergoing major surgery. Br J Anaesth, 2016, 116(1): 63-69.
13.	Tsipotis E, Price LL, Jaber BL, et al. Hospital-associated hypernatremia spectrum and clinical outcomes in an unselected cohort. Am J Med, 2018, 131(1): 72-82.
14.	Thongprayoon C, Cheungpasitporn W, Yap JQ, et al. Increased mortality risk associated with serum sodium variations and borderline hypo- and hypernatremia in hospitalized adults. Nephrol Dial Transplant, 2019. [Epub ahead of print].
15.	Lee SB, Oh JH, Park JH, et al. Differences in youngest-old, middle-old, and oldest-old patients who visit the emergency department. Clin Exp Emerg Med, 2018, 5(4): 249-255.
16.	Nashef SAM, Roques F, Michel P, et al. European system for cardiac operative risk evaluation (EuroSCORE). Eur J Cardiothorac Surg, 1999, 16(1): 9-13.
17.	穆心苇, 牛永胜, 施乾坤, 等. 临床路径在冠状动脉旁路移植术后ICU管理中的应用. 中华医院管理杂志, 2005, 21(3): 165-167.
18.	Ely EW, Bernard GR, Speroff T, et al. Delirium in mechanically ventilated patients: Validity and reliability of the Confusion Assessment Method for the intensive care unit (CAM-ICU). JAMA, 2001, 286(21): 2703-2710.
19.	Muhsin SA, Mount DB. Diagnosis and treatment of hypernatremia. Best Pract Res Clin Endocrinol Metab, 2016, 30(2): 189-203.
20.	Waite MD, Fuhrman SA, Badawi O, et al. Intensive care unit-acquired hypernatremia is an independent predictor of increased mortality and length of stay. J Crit Care, 2013, 28(4): 405-412.
21.	Yang Y, Shen C, Lu J, et al. Early continuous ultrafiltration in Chinese patients with congestive heart failure (EUC-CHF): study protocol for an open-label registry-based prospective clinical trial. BMC Cardiovasc Disord, 2019, 19(1): 249.
22.	Maldonado JR, Wysong A, Van Der Starre PJA, et al. Dexmedetomidine and the reduction of postoperative delirium after cardiac surgery. Psychosomatics, 2009, 50(3): 206-217.
23.	吴庆琛, 王小文, 张诚, 等. 右美托咪定对体外循环心脏手术后患者围术期预后影响的系统评价与Meta分析. 中国胸心血管外科临床杂志, 2018, 25(4): 325-332.

1. Smulter N, Lingehall HC, Gustafson Y, et al. Delirium after cardiac surgery: Incidence and risk factors. Interact Cardiovasc Thorac Surg, 2013, 17(5): 790-796.
2. Bucerius J, Gummert JF, Borger MA, et al. Predictors of delirium after cardiac surgery delirium: Effect of beating-heart (off-pump) surgery. J Thorac Cardiovasc Surg, 2004, 127(1): 57-64.
3. Eriksson M, Samuelsson E, Gustafson Y, et al. Delirium after coronary bypass surgery evaluated by the organic brain syndrome protocol. Scand Cardiovasc J, 2002, 36(4): 250-255.
4. Rudolph JL, Jones RN, Levkoff SE, et al. Derivation and validation of a preoperative prediction rule for delirium after cardiac surgery. Circulation, 2009, 119(2): 229-236.
5. Crocker E, Beggs T, Hassan A, et al. Long-term effects of postoperative delirium in patients undergoing cardiac operation: a systematic review. Ann Thorac Surg, 2016, 102(4): 1391-1399.
6. Hollinger A, Siegemund M, Goettel N, et al. Postoperative delirium in cardiac surgery: An unavoidable menace? J Cardiothorac Vasc Anesth, 2015, 29(6): 1677-1687.
7. Falsini G, Grotti S, Porto I, et al. Long-term prognostic value of delirium in elderly patients with acute cardiac diseases admitted to two cardiac intensive care units: a prospective study (DELIRIUM CORDIS). Eur Heart J Acute Cardiovasc Care, 2017, 7(7): 661-670.
8. Hirsch J, DePalma G, Tsai TT, et al. Impact of intraoperative hypotension and blood pressure fluctuations on early postoperative delirium after non-cardiac surgery. Br J Anaesth, 2015, 115(3): 418-426.
9. Plaschke K, Fichtenkamm P, Schramm C, et al. Early postoperative delirium after open-heart cardiac surgery is associated with decreased bispectral EEG and increased cortisol and interleukin-6. Intensive Care Med, 2010, 36(12): 2081-2089.
10. Stelfox HT, Ahmed SB, Zygun D, et al. Characterization of intensive care unit acquired hyponatremia and hypernatremia following cardiac surgery. Can J Anaesth, Springer, 2010, 57(7): 650-658.
11. Lindner G, Funk GC, Lassnigg A, et al. Intensive care-acquired hypernatremia after major cardiothoracic surgery is associated with increased mortality. Intensive Care Med, 2010, 36(10): 1718-1723.
12. Cecconi M, Hochrieser H, Chew M, et al. Preoperative abnormalities in serum sodium concentrations are associated with higher in-hospital mortality in patients undergoing major surgery. Br J Anaesth, 2016, 116(1): 63-69.
13. Tsipotis E, Price LL, Jaber BL, et al. Hospital-associated hypernatremia spectrum and clinical outcomes in an unselected cohort. Am J Med, 2018, 131(1): 72-82.
14. Thongprayoon C, Cheungpasitporn W, Yap JQ, et al. Increased mortality risk associated with serum sodium variations and borderline hypo- and hypernatremia in hospitalized adults. Nephrol Dial Transplant, 2019. [Epub ahead of print].
15. Lee SB, Oh JH, Park JH, et al. Differences in youngest-old, middle-old, and oldest-old patients who visit the emergency department. Clin Exp Emerg Med, 2018, 5(4): 249-255.
16. Nashef SAM, Roques F, Michel P, et al. European system for cardiac operative risk evaluation (EuroSCORE). Eur J Cardiothorac Surg, 1999, 16(1): 9-13.
17. 穆心苇, 牛永胜, 施乾坤, 等. 临床路径在冠状动脉旁路移植术后ICU管理中的应用. 中华医院管理杂志, 2005, 21(3): 165-167.
18. Ely EW, Bernard GR, Speroff T, et al. Delirium in mechanically ventilated patients: Validity and reliability of the Confusion Assessment Method for the intensive care unit (CAM-ICU). JAMA, 2001, 286(21): 2703-2710.
19. Muhsin SA, Mount DB. Diagnosis and treatment of hypernatremia. Best Pract Res Clin Endocrinol Metab, 2016, 30(2): 189-203.
20. Waite MD, Fuhrman SA, Badawi O, et al. Intensive care unit-acquired hypernatremia is an independent predictor of increased mortality and length of stay. J Crit Care, 2013, 28(4): 405-412.
21. Yang Y, Shen C, Lu J, et al. Early continuous ultrafiltration in Chinese patients with congestive heart failure (EUC-CHF): study protocol for an open-label registry-based prospective clinical trial. BMC Cardiovasc Disord, 2019, 19(1): 249.
22. Maldonado JR, Wysong A, Van Der Starre PJA, et al. Dexmedetomidine and the reduction of postoperative delirium after cardiac surgery. Psychosomatics, 2009, 50(3): 206-217.
23. 吴庆琛, 王小文, 张诚, 等. 右美托咪定对体外循环心脏手术后患者围术期预后影响的系统评价与Meta分析. 中国胸心血管外科临床杂志, 2018, 25(4): 325-332.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Hypernatremia increases the incidence of late delirium after cardiac surgery

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content