Key result
Elevated day-1 postoperative cortisol links to ~6-fold higher delirium risk after off-pump CABG.
Why the study?
Delirium is a prevalent complication following CABG, and this study aimed to assess the correlation between elevated serum cortisol levels and postoperative delirium after off-pump CABG.
Does elevated serum cortisol correlate with the occurrence of postoperative delirium in patients following off-pump CABG?
Cross-Sectional (n=44)
Single-blind
No
Does elevated serum cortisol correlate with the occurrence of postoperative delirium in patients following off-pump CABG?
Elevated serum cortisol on the first postoperative day is significantly associated with an increased risk of postoperative delirium and longer ICU and hospital stays following off-pump CABG.
Elevated cortisol may aid delirium risk stratification after off-pump CABG; hypothesis-generating and needs prospective confirmation.
Background: Following coronary artery bypass grafting (CABG), delirium emerges as a prevalent complication. This study aimed to assess the correlation between elevated serum cortisol levels and the occurrence of postoperative delirium subsequent to off-pump CABG. Methods: Conducted in the Department of Cardiac Surgery at BSMMU from October 2020 to September 2022, this comparative cross-sectional study included a total of 44 participants. Subjects, meeting specific criteria, were purposefully assigned to two groups based on off-pump CABG. Group A (n = 22) consisted of patients with normal serum cortisol levels, while Group B (n = 22) comprised individuals with high serum cortisol levels on the first postoperative day. Delirium onset was assessed at the bedside in the ICU on the 1st, 2nd, 3rd, 4th, and 5th postoperative days using standard tools, namely the Richmond Agitation Sedation score (RASS) and The Confusion Assessment Method (CAM-ICU). Data were collected based on the presence or absence of delirium. Statistical analysis utilized SPSS version 26.0, employing an independent Student’s t-test for continuous data and chi-square and Fischer’s exact test for categorical data. A p-value ≤ 0.05 was considered statistically significant. Results: Group-A had a mean age of 54.50 ± 17.97, and Group-B had a mean age of 55.22 ± 15.45, both with a male predominance (81.81% and 86.36% respectively). The mean serum cortisol level was significantly higher in Group B (829.71 ± vs. 389.98 ± 68.77). Postoperative delirium occurred in 27.3% of Group B patients, statistically significant compared to the 4.5% in Group A. However, patients in Group B who developed delirium experienced significantly longer postoperative ICU and hospital stays (79.29 ± 12.27 vs. 11.44 ± 2.85, p ≤ 0.05). There was one mortality in Group B, which was statistically not significant. Conclusion: This study observed a significant association between elevated serum cortisol levels in the postoperative period and the occurrence of postoperative delirium after off-pump coronary artery bypass grafting.
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Jha et al. (2024) conducted a cross-sectional in Postoperative delirium following off-pump coronary artery bypass grafting (n=44). High serum cortisol level (>690 nmol/l) on the first postoperative day vs. Normal serum cortisol level (138-690 nmol/l) on the first postoperative day was evaluated on Incidence of postoperative delirium (p=0.039). Elevated serum cortisol levels on the first postoperative day were significantly associated with a higher incidence of postoperative delirium (27.3% vs 4.5%, p=0.039) following off-pump CABG.
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