Is cortisol the key to the pathogenesis of delirium after coronary artery bypass graft surgery?

Kaźmierski, Jakub; Kłoszewska, Iwona

doi:10.1186/cc9372

Cited by 21 publications

(16 citation statements)

References 16 publications

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“…According to recent studies, the most prominent factors contributing to postoperative delirium include comorbid load (atrial fibrillation, prior stroke, anemia, peripheral vascular disease) as well as psychiatric comorbidity such as cognitive impairment and preoperative major depressive disorder (MDD) [5-7]. The pathological association between MDD and postoperative delirium is unclear.…”

Section: Introductionmentioning

confidence: 99%

“…The pathological association between MDD and postoperative delirium is unclear. These disorders have been proposed to be linked by a greater rise in plasma cortisol, interleukins and abnormalities in amino acids [5,7,8]. However, few studies have attempted to or been able to identify the pathogenesis of delirium following cardiac interventions, although two recent important studies suggest an association with raised postoperative cortisol levels [9,10], whilst Plaschke and colleagues have additionally implicated increased levels of IL-6 [10].…”

Section: Introductionmentioning

confidence: 99%

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Cortisol levels and neuropsychiatric diagnosis as markers of postoperative delirium: a prospective cohort study

Kaźmierski

Banyś

Latek³

et al. 2013

Critical Care

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100

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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.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cortisol levels and neuropsychiatric diagnosis as markers of postoperative delirium: a prospective cohort study

Kaźmierski

Banyś

Latek³

et al. 2013

Critical Care

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100

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“…Current thinking implicates cortisol and cytokine abnormalities in cognitive impairment and delirium [7,24,25,26]. Higher cortisol measures have been reported in AD and are associated with poorer memory performance in subjects with cognitive decline [26,27].…”

Section: Introductionmentioning

confidence: 99%

“…A number of studies have investigated risk factors for postoperative delirium, but findings have been heterogeneous. To date, the most consistently reported independent associations with delirium in studies of cardiac surgery include older age, preoperative dementia, nonclassified preexisting cognitive impairment (PreCI; usually both dementia and milder forms of cognitive impairment) and major depressive disorder (MDD) [7,8,9,10]. The other well-established risk factors of delirium include medical conditions such as dehydration, malnutrition, electrolyte or metabolic abnormalities, hypoglycemia, hypoxia, infection, hepatic impairment, renal impairment, cardiac ischemia, multiple medications and alcohol abuse [5,11,12,13,14].…”

Section: Introductionmentioning

confidence: 99%

Mild Cognitive Impairment with Associated Inflammatory and Cortisol Alterations as Independent Risk Factor for Postoperative Delirium

Kaźmierski¹,

Banyś²,

Latek³

et al. 2014

Dement Geriatr Cogn Disord

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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.

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“…3 An elevated level of cortisol was found to be an important factor involved in delirium after coronary artery bypass graft surgery. 7 Another study in individuals age 65 years or older found that S100B is the strongest independent marker. 8 Studies on structural and functional brain imaging, neurotransmitter studies, as well electrophysiologic tests suggest the importance of cerebral cortical and subcortical areas, especially the frontal lobe, subcortical regions, and the right hemisphere.…”

Section: Neuropathologymentioning

confidence: 99%

A 55-Year-Old Obese Woman with Acute Onset of Psychosis

Parab¹,

Mall²

2015

Psychiatric Annals

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Is cortisol the key to the pathogenesis of delirium after coronary artery bypass graft surgery?

Cited by 21 publications

References 16 publications

Cortisol levels and neuropsychiatric diagnosis as markers of postoperative delirium: a prospective cohort study

Cortisol levels and neuropsychiatric diagnosis as markers of postoperative delirium: a prospective cohort study

Mild Cognitive Impairment with Associated Inflammatory and Cortisol Alterations as Independent Risk Factor for Postoperative Delirium

A 55-Year-Old Obese Woman with Acute Onset of Psychosis

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