What is the clinical evidence from this study?

Study design: Observational. Population: Postoperative delirium after CABG (n=1098). Intervention: CARDEL Index. Primary outcome: Postoperative delirium detection (AUC 0.664, p=<0.001).

March 1, 2021Clinical Interventions in Aging31 citationsOpen Access

Cardiac Delirium Index for Predicting the Occurrence of Postoperative Delirium in Adult Patients After Coronary Artery Bypass Grafting

Q: What are the key findings of this study?

The CARDEL Index predicted postoperative delirium in adult patients after CABG with an area under the curve of 0.664 (P<0.001) at a cut-off value of 8.08.

KLKacper Lechowicz ASAleksandra Szylińska MLMariusz Listewnik

Key Result

The CARDEL Index predicted postoperative delirium in adult patients after CABG with an area under the curve of 0.664 (P<0.001) at a cut-off value of 8.08.

Study Design

Type

Observational (n=1,098)

Structured PICO

Does the CARDEL Index predict postoperative delirium in adult patients after CABG?

Population

1,098 adult patients who underwent isolated CABG procedures between 2017 and 2019, assessed for postoperative delirium.

Exposure

CARDEL Index (composed of advancing age, preoperative glycated hemoglobin, and platelet-to-WBC ratio)

Outcome

Postoperative delirium (POD)

The CARDEL Index, incorporating age, HbA1c, and platelet-to-WBC ratio, is a potentially valuable tool for predicting postoperative delirium after CABG.

Main Result

Effect estimate: AUC 0.664

p-value: p=<0.001

Abstract

BACKGROUND: Postoperative delirium (POD) is a serious complication of cardiac surgery. It is an acute neuropsychiatric syndrome. The aim of this study was to analyze the CARDEL Index, composed of advancing age, preoperative glycated hemoglobin and the platelet-to-WBC ratio (PWR) previously described and calculated, using a different patient database, to assess its usefulness as a marker for predicting postoperative delirium after coronary artery by-pass grafting (CABG). METHODS: A retrospective analysis of 1098 patients who underwent, isolated CABG procedures between 2017 and 2019 was performed. RESULTS: Within the study group, 164/1098 (14.93%) patients were diagnosed with delirium. Preoperative inflammatory parameters were elevated in patients with delirium: White Blood Cell count (p=0.003), Neutrophil count (p=0.016) and C-reactive protein (p<0.001). A decrease in preoperative PWR was shown in patients with delirium (p=0.008). Delirious patients spent more time mechanically ventilated (p<0.001) and had longer hospitalization times (p=0.002). Mortality at 1 year was significantly higher in patients with POD (p<0.001). The CARDEL Index in this study group for POD detection has the largest area under the curve (AUC) of 0.664 (p<0.001) and a cut-off value of 8.08. CONCLUSION: CARDEL Index may be treated as a potentially valuable tool for delirium prediction in patients after CABG.

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