CARDIOVASCULAR JOURNAL OF AFRICA • Volume 33, No 6, November/December 2022 296 AFRICA The role of inflammatory parameters in the prediction of postoperative delirium in patients undergoing coronary artery bypass grafting Hüseyin Şaşkin, Kazim Serhan Özcan, Serhan Yildirim Abstract Objective: In this study, we aimed to evaluate the association of pre-operative and early postoperative inflammatory parameters with postoperative delirium in patients operated on for coronary artery bypass grafting. Methods: The data of 1 279 cardiac surgery patients operated on between June 2014 and March 2020 were analysed retrospectively. Among these, 777 (61.2%) patients operated on for isolated coronary artery bypass grafting surgery with cardiopulmonary bypass were enrolled. Two groups were formed. The patients who developed postoperative delirium were placed in group 1 (n = 187) and the patients with uneventful postoperative follow up (n = 590) were enrolled in group 2. Results: Pre- and early postoperative mean platelet volume, C-reactive protein level, erythrocyte sedimentation rate, platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio were elevated in group 1 (p = 0.0001). The APACHE II score and duration of hospital and intensive care unit stay were significantly elevated in group 1 (p < 0.05). An early-stage neurological event was observed in eight patients (4.3%) in group 1 and 12 patients (2%) in group 2, which was not statistically significantly different between the groups (p = 0.09). In-hospital mortality was observed in three patients (1.6%) in group 1 and five patients (0.8%) in group 2, which did not show a statistically significant difference (p > 0.05). In univariate and multivariate regression analysis, the pre-operative platelet-to-lymphocyte ratio (p = 0.013), mean platelet volume (p = 0.0001) and erythrocyte sedimentation rate (p = 0.002) were determined as independent risk factors for the occurrence of delirium in the early postoperative period. Also, the postoperative platelet-to-lymphocyte ratio (p = 0.0001), neutrophil-to-lymphocyte ratio (p = 0.0001) and erythrocyte sedimentation rate (p = 0.0001) were determined as independent risk factors for the occurrence of delirium in the early postoperative period. Conclusion: Pre- and early postoperative inflammatory parameters were observed to be predictors of postoperative delirium in patients operated on for coronary artery bypass grafting. Keywords: coronary artery bypass grafting surgery, delirium, inflammation Submitted 16/5/21, accepted 7/2/22 Published online 4/3/22 Cardiovasc J Afr 2022; 296–303 www.cvja.co.za DOI: 10.5830/CVJA-2022-008 Coronary artery bypass grafting (CABG) is a life-saving procedure with acceptable complication and mortality rates.1 Most of the mortality and morbidity events associated with cardiac surgery are related to cerebrovascular complications.2,3 Brain injury associated with CABG may present as a pure neurological complication or a neuropsychological dysfunction.2 Postoperative delirium (POD) is reported in 26 to 52% of patients undergoing cardiac surgery and is associated with increased length of intensive care unit (ICU) stay, morbidity, mortality and cognitive decline.4-6 Although several risk factors have been defined, the exact underlying pathophysiology of POD has not been clearly elucidated. Neuro-inflammation is considered to be one of the possible contributors for POD.7 Surgical trauma initiates an inflammatory response, which promotes healing; however, when this response is dysregulated, it can result in a neuro-inflammatory response, leading to postoperative cognitive decline.8 The cascade of events starts with generalised inflammation, leading to endothelial dysfunction, which increases the permeability of the blood–brain barrier and leads to the development of inflammatory changes of the nervous tissue, damage to neurons and exaggerated responses of microglial cells.9 Research involving biomarkers for diagnosis and prognosis did not indicate any single marker for delirium screening, but rather a panel of biomarkers were identified that may lead to an accurate and timely diagnosis of delirium.10 A complete blood count (CBC) is a routine test performed on almost every patient in daily practice. The information provided by a CBC is greater than what is commonly thought and its use cannot be overestimated.9 Inflammation leads to a transient increase in white blood cells (WBC) and a decrease in platelets. Recently, neutrophil-to-lymphocyte ratio (NLR) and platelet-tolymphocyte ratio (PLR) were identified as prognostic markers in various cardiovascular and cerebrovascular diseases.11-13 Egberts et al. observed that increased NLR was a predictor of delirium in elderly patients admitted to a geriatric unit.14 Recently, Kotfis Cardiovascular Surgery Clinic, Derince Training and Research Hospital, Health Sciences University, Kocaeli, Turkey Hüseyin Şaşkın, MD, sueda_hs@yahoo.com Department of Cardiology, Siyami Ersek Training and Research Hospital, Health Sciences University, İstanbul, Turkey Kazim Serhan Özcan, MD Neurology Clinic, Derince Training and Research Hospital, Health Sciences University, Kocaeli, Turkey Serhan Yildirim, MD
RkJQdWJsaXNoZXIy NDIzNzc=