CARDIOVASCULAR JOURNAL OF AFRICA • Volume 33, No 6, November/December 2022 300 AFRICA Among the 777 patients with normal sinus rhythm at baseline, new-onset AF occurred in 54 patients (28.7%) in group 1 and in 107 patients (18.1%) in group 2, indicating a statistically significant difference (p = 0.002). Eleven patients (5.9%) in group 1 and six (1.0%) in group 2 were re-operated for sternal detachment as one of the major causes of postoperative morbidity and sternal infection, for which the difference was statistically significant between the groups (p = 0.0001). Univariate and multivariate regression analyses of the pre-operative factors affecting POD are shown in Table 6. Additionally, univariate and multivariate regression analyses of the operative and postoperative factors affecting POD are shown in Table 7. In univariate regression analysis, increased pre- and early postoperative MPV, PLR, NLR, ESR and CRP levels, and increased APACHE II scores were associated with POD. In multivariate regression analysis, only increased pre-operative levels of MPV (OR = 3.82, 95% CI: 1.98–7.38, p = 0.0001), and ESR (OR = 1.15, 95% CI: 1.05–1.25, p = 0.002) and PLR (OR = 1.04, 95% CI: 1.01–1.08, p = 0.013), and increased early postoperative ESR levels (OR = 1.07, 95% CI: 1.04–1.10, p = 0.0001), and PLR (OR = 1.06, 95% CI: 1.03–1.09, p = 0.0001) and NLR (OR = 2.72, 95% CI: 1.77–4.19, p = 0.0001), as well as increased APACHE II scores (OR = 1.93, 95% CI: 1.61–2.33, p = 0.0001) remained as independent predictors of POD. The result of the analyses showed not only that the regression model was significant [F (11, 764) = 136.23, p < 0.0001] but also that 66% (R2 adjusted = 0.66) of the variance of POD, as the dependent variable, was expressed by the independent variables. In multivariate logistic regression analysis, the pre- and first postoperative day PLR to predict POD was determined by ROC curve analysis (Fig. 1). Cut-off levels for pre- and postoperative PLR were 145.1 and 147.0, respectively. The area under the curve (AUC) values for pre- and postoperative PLR were 0.81 (95% CI: 0.78–0.85, p = 0.0001) and 0.86 (95% CI: 0.75–0.81, p = 0.0001), respectively. The sensitivity and specificity of the pre-operative PLR cut-off value were 78.1 and 77.5%, respectively. The sensitivity and specificity of the postoperative PLR cut-off value were 78.1 and 76.5%, respectively. The pre-operative and first postoperative day ESR levels to predict POD were determined by ROC curve analysis (Fig. 2). Table 5. Intra-operative and postoperative data of the patients Characteristics Patients with delirium, group 1 (n = 187) Patients without delirium, group 2 (n = 590) p-value Aortic cross-clamp time (min) 51.6 ± 13.8 (median: 52.5, range: 21–81) 52.3 ± 13.3 (median: 53.2, range: 18–91) 0.56** Cardiopulmonary bypass time (min) 83.8 ± 15.3 (median: 85.9, range: 43–126) 82.7 ± 16.3 (median: 85, range: 42–121) 0.31** Number of anastomoses 3.27 ± 0.97 (median: 3.3, range: 1–6) 3.29 ± 0.98 (median: 3.4, range: 1–5) 0.72** Use of blood products (n, %) 64 (34.2) 227 (38.5) 0.30* Use of intravenous dexketoprofen (n, %) 60 (32.1) 197 (33.4) 0.79* Amount of drainage (ml) 351 ± 188 (median: 305, range: 150–1250) 352 ± 167 (median: 316, range: 150–1200) 0.48** Intubation time (hours) 5.7 ± 2.0 (median: 5.4, range: 3–15) 5.8 ± 1.9 (median: 5.6, range: 3–22) 0.15** Stay in the intensive care unit (h) 36.6 ± 17.8 (median: 34, range: 17–91) 24.9 ± 10.6 (median: 22, range: 17–82) 0.0001** APACHE II scores 11.8 ± 2.3 (median: 12.1, range: 5–16) 8.7 ± 1.6 (median: 8.5, range: 6–15) 0.0001** Total duration of hospital stay (days) 6.7 ± 2.0 (median: 6.2, range: 5–18) 5.9 ± 1.7 (median: 5.5, range: 5–18) 0.0001** Use of inotropic support (n, %) 13 (7.0) 34 (5.8) 0.55* *Pearson’s chi-squared test or Fisher’s exact test. **Mann–Whitney U-test. Pre-operative PLR Postoperative PLR Reference line Sensitivity 1.0 0.8 0.6 0.4 0.2 0.0 0.0 0.2 0.4 0.6 0.8 1.0 1 – Specificity Fig. 1. ROC curve analysis of pre- and postoperative PLR levels to predict postoperative delirium Sensitivity 1.0 0.8 0.6 0.4 0.2 0.0 0.0 0.2 0.4 0.6 0.8 1.0 1 – Specificity Pre-operative ESR Postoperative ESR Reference line Fig. 2. ROC curve analysis of pre- and postoperative ESR levels to predict postoperative delirium
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