IntroductionThe pathophysiology of delirium after cardiac surgery is largely unknown. The purpose of this study was to investigate whether increased concentration of preoperative and postoperative plasma cortisol predicts the development of delirium after coronary artery bypass graft surgery. A second aim was to assess whether the association between cortisol and delirium is stress related or mediated by other pathologies, such as major depressive disorder (MDD) or cognitive impairment.MethodsThe patients were examined 1 day preoperatively with the Mini International Neuropsychiatric Interview and the Montreal Cognitive Assessment and the Trail Making Test to screen for depression and for cognitive impairment, respectively. Blood samples for cortisol levels were collected both preoperatively and postoperatively. The Confusion Assessment Method for the Intensive Care Unit was used within the first 5 days postoperatively to screen for a diagnosis of delirium.ResultsPostoperative delirium developed in 36% (41 of 113) of participants. Multivariate logistic regression analysis revealed two groups independently associated with an increased risk of developing delirium: those with preoperatively raised cortisol levels; and those with a preoperative diagnosis of MDD associated with raised levels of cortisol postoperatively. According to receiver operating characteristic analysis, the most optimal cutoff values of the preoperative and postoperative cortisol concentration that predict the development of delirium were 353.55 nmol/l and 994.10 nmol/l, respectively.ConclusionRaised perioperative plasma cortisol concentrations are associated with delirium after coronary artery bypass graft surgery. This may be an important pathophysiological consideration in the increased risk of postoperative delirium seen in patients with a preoperative diagnosis of MDD.

Aims: The present study aimed to determine the impact of mild cognitive impairment (MCI) on the development of postoperative delirium and, secondly, to assess the association between MCI and raised perioperative cortisol, cytokine, cobalamin and homocysteine levels. Methods: The study recruited 113 consecutive adult patients scheduled for cardiac surgery with cardiopulmonary bypass. The patients were examined preoperatively with the Montreal Cognitive Assessment and Trail Making Test. A diagnosis of MCI was established based upon the criteria of the National Institute on Aging and Alzheimer's Association. Patients were screened for delirium within the first 5 days postoperatively. Results: MCI was diagnosed in 24.8% of the patients, whereas the frequency of delirium was 36%. A multivariate analysis demonstrated that individuals with MCI were at a significantly higher risk of postoperative delirium (OR = 6.33, p = 0.002). Preoperative cortisol, postoperative cortisol and IL-2 plasma levels were higher in the MCI group as compared to non-MCI subjects. Conclusion: MCI is associated with a higher risk of postoperative delirium. Perioperative cortisol and inflammatory alterations observed in MCI may provide a physiological explanation for this increased risk.

The present study suggests that raised postoperative cytokine concentrations are associated with delirium after CABG surgery. Postoperative monitoring of pro-inflammatory markers combined with regular surveillance may be helpful in the early detection of postoperative delirium in this patient group.

IntroductionDelirium affects 11% to 47% of post-operative cardiac surgery patients and is associated with higher mortality and morbidity rates. However, the pathophysiology of this syndrome is largely unknown.ObjectivesTo investigate whether increased concentration of pre- and postoperative plasma cortisol predicts the development of delirium after coronary artery bypass graft surgery (CABG). Secondly, to assess whether the association between cortisol and delirium is stress-related or mediated by other pathologies, such as major depressive disorder (MDD) or cognitive impairment.MethodsThe patients were examined one day preoperatively with Mini International Neuropsychiatric Interview and Montreal Cognitive Assessment to screen for depression and cognitive impairment, respectively. Blood samples for cortisol levels were collected both pre- and post-operatively. The Confusion Assessment Method was used within the first five days postoperatively to screen for a diagnosis of delirium.ResultsPostoperative delirium developed in 36% (41of 113) of participants. Multivariate logistic regression analysis revealed two groups independently associated with an increased risk of developing post-operative delirium:Those with pre-operatively raised cortisol levels andThose with a pre-operative diagnosis of MDD associated with raised levels of cortisol post-operatively. According to ROCanalysis the most optimal cutoff values of the preoperative and postoperative cortisol concentration which predict the development of delirium were 353.55 nmol/L, and 994.10 nmol/L, respectively.ConclusionRaised peri-operative plasma cortisol concentrations are associated with delirium after CABG surgery. This may be an important pathophysiological consideration in the increased risk of post-operative delirium seen in patients with a preoperative diagnosis of MDD.

A b s t r a c tA 67-year-old woman with symptoms of cardiogenic shock is reported. Heart rupture as a complication of acute coronary syndrome was diagnosed. Cardiorrhaphy was performed. In the next stage coronary angiography was performed. Subtotal stenosis of a small marginal branch was responsible for this incident.Key words: heart rupture, acute coronary syndrome S t r e s z c z e n i e Przedstawiono przypadek 67-letniej chorej przyjętej z wstępnym rozpoznaniem wstrząsu kardiogennego. Rozpoznano pęknięcie serca jako powikłanie ostrego zespołu wieńcowego. Kardiochirurgicznie zszyto uszkodzony mięsień sercowy. W kolejnym etapie wykonano koronarografię. Ustalono, że za zaistniały epizod odpowiada subtotalnie zwężona mała gałąź marginalna.Słowa kluczowe: pęknięcie serca, ostry zespół wieńcowy