Abstract
Background: Delirium is a common occurrence in patients admitted to the intensive care unit and is related to mortality and morbidity. Malnutrition is a predisposing factor for the development of delirium. Nevertheless, whether the nutritional status on admission anticipates the development of delirium in patients with acute cardiovascular diseases remains unknown. Objective: This study aims to assess the correlation between the nutritional status on admission using the nutritional index and the development of delirium in the coronary intensive care unit. Design: We examined 653 consecutive patients (mean age: 70 ± 14 years) admitted to the coronary intensive care unit of Juntendo University Hospital between January 2015 and December 2016. We evaluated three nutritional indices frequently used to assess the nutritional status, i.e., Geriatric Nutritional Risk Index (GNRI), Prognostic Nutritional Index (PNI), and Controlling Nutritional Status (CONUT). We defined delirium as patients with a delirium score >4 using the Intensive Care Delirium Screening Checklist. Results: Delirium was present in 58 patients. All nutritional indices exhibited a tendency for malnutrition in the delirium group compared with the non-delirium group (GNRI, 86.5 ± 9.38 versus 91.6 ± 9.89; PNI, 36.4 ± 6.95 versus 41.6 ± 7.62; CONUT, 5.88 ± 3.00 versus 3.61 ± 2.56; for all, p < 0.001). Furthermore, the maximum delirium score increased progressively from the low- to the high-risk group, as evaluated by each nutritional index (GNRI, PNI, CONUT; for all, p < 0.001). A multivariate analysis revealed that the PNI and CONUT were independent risk factors for the occurrence of delirium. Conclusions: A marked correlation exists between the nutritional index on admission, especially PNI and CONUT, and the development of delirium in patients with acute cardiovascular diseases, suggesting that malnutrition assessment upon admission could help identify patients at high risk of developing delirium.
Highlights
Delirium is a transient neurocognitive disorder that is characterized by inattention, cognitive dysfunction, and behavioral abnormalities, which almost always develop in association with an underlying medical condition
Delirium is a common occurrence in patients who are admitted to intensive care units
Albumin, total cholesterol (TC), HDL-C, and LDL-C levels were significantly lower, whereas creatinine, C-reactive protein (CRP), and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels were significantly higher in the delirium group
Summary
Delirium is a transient neurocognitive disorder that is characterized by inattention, cognitive dysfunction, and behavioral abnormalities, which almost always develop in association with an underlying medical condition. Delirium typically has an acute onset and exhibits a fluctuating course [1]. Delirium is a common occurrence in patients who are admitted to intensive care units. Several studies have assessed the prevalence of delirium in various populations. One study found that one-third of all general medical patients aged ≥70 years have delirium [1]. Delirium is a common occurrence in patients admitted to the intensive care unit and is related to mortality and morbidity. Malnutrition is a predisposing factor for the development of delirium. Whether the nutritional status on admission anticipates the development of delirium in patients with acute cardiovascular diseases remains unknown
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