Abstract
BackgroundBlood glucose variability is associated with poor prognosis after cardiac surgery, but the relationship between glucose variability and postoperative delirium in patients with acute aortic dissection is unclear. The study aims to investigate the association of blood glucose variability with postoperative delirium in acute aortic dissection patients.MethodsWe prospectively analyzed 257 patients including 103 patients with delirium. The patients were divided into two groups according to whether delirium was present. The outcome measures were postoperative delirium, the length of the Intensive Care Unit stay, and the duration of hospital stay. Multivariable Cox competing risk survival models was used to assess.ResultsA total of 257 subjects were enrolled, including 103 patients with delirium. There were statistically significant differences between the two groups in body mass index, history of cardiac surgery, first admission blood glucose, white blood cell counts, Acute Physiology and Chronic Health Evaluation II score, hypoxemia, mechanical ventilation duration, and the length of Intensive Care Unit stay(P < 0.05). The delirium group exhibited significantly higher values of the mean of blood glucose (MBG) and the standard deviation of blood glucose (SDBG) than in the non-delirium group(P < 0.05). In model 1, the adjusted hazard ratio (AHR) of the standard deviation of blood glucose was 1.436(P < 0.05). In Model 2, the standard deviation of blood glucose (AHR = 1.418, 95%CI = 1.195–1.681, P < 0.05) remained significant after adjusting for confounders. The area under the curve of the SDBG was 0.763(95%CI = 0.704–0.821, P < 0.01). The sensitivity was 81.6%, and the specificity was 57.8%.ConclusionsGlucose variability is associated with the risk of delirium in patients after aortic dissection surgery, and high glycemic variability increases the risk of postoperative delirium.
Highlights
Blood glucose variability is associated with poor prognosis after cardiac surgery, but the relationship between glucose variability and postoperative delirium in patients with acute aortic dissection is unclear
More attention has been paid to the study of blood glucose variability (GV) on disease progression and prognosis of patients, and it has important clinical significance for monitoring and controlling blood GV in severe patients [9, 10]
Only one article has pointed out that hypoglycemia is positively correlated with delirium in mixed Intensive Care Unit (ICU) diabetic patients, but high blood GV is not correlated with delirium [14]
Summary
Blood glucose variability is associated with poor prognosis after cardiac surgery, but the relationship between glucose variability and postoperative delirium in patients with acute aortic dissection is unclear. The study aims to investigate the association of blood glucose variability with postoperative delirium in acute aortic dissection patients. Postoperative delirium (POD) is a severe cerebral dysfunction, and is characterized by episodes of confusion, inattention, thinking disorder and altered level of consciousness [1]. It is one of the neurological complications after cardiac surgery with an incidence of as high as 11.0–54.9% [2, 3]. There is no study on the correlation between POD and blood GV in patients after cardiac surgery, nor the effect of blood GV on POD after acute aortic dissection (AAD)
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