White-matter hyperintensities predict delirium after cardiac surgery.

OBJECTIVES: Postoperative delirium is a common psychiatric disorder among patients who undergo cardiac surgery. Although several studies have investigated risk factors for delirium after cardiac surgery, the association between delirium and cerebral white-matter hyperintensities (WMH) on magnetic resonance (MR) imaging has not been previously studied. The aim of this study was to identify general risk factors for delirium, as well as to examine the specific relationship between WMH and delirium. DESIGN: Retrospective chart review. SETTING: University hospital. PARTICIPANTS: A total of 130 patients who underwent cardiac surgery. MEASUREMENTS: Variables recorded included patient demographics, comorbidities, mental health, laboratory data, surgical information, and cerebrovascular disease. The presence of WMH was assessed using MR images. Two groups of patients were compared (patients with and without delirium) using both univariate and multiple logistic analyses. RESULTS: Delirium occurred in 18 patients (13.8%) and patients with delirium were significantly older than patients who did not develop delirium. The prevalence of severe WMH (Fazekas score = 3) was significantly higher in patients with delirium. Three independent predictors of delirium were identified: abnormal creatinine (odds ratio [OR]: 4.5; 95% confidence interval [CI]: 1.4-13.9), severe WMH (OR: 3.9; 95% CI: 1.2-12.5), and duration of surgery (OR: 1.4; 95% CI: 1.0-1.8). CONCLUSIONS: The results of this study suggest that white-matter abnormality is one of the most important risk factors for development of delirium after cardiac surgery. These factors can be used for prediction and prevention of delirium following cardiac surgery.

Predictive factors for agitation severity of hyperactive delirium in terminally ill cancer patients in a general hospital using ordered logistic regression analysis.

BACKGROUND: Despite the fact that many cancer patients worldwide die in general hospitals, there are few reports of the analysis of delirium in terminally ill cancer patients in this setting. PURPOSE: This study aimed to identify predictive factors for agitation severity of hyperactive delirium in terminally ill cancer patients in a general hospital. METHODS: Participants were 182 consecutively admitted terminally ill cancer patients who died in a Japanese general hospital between April 2009 and March 2011. Variables present one week before death were extracted from the clinical records for regression analysis of factors potentially related to agitation severity of delirium. The prevalence and agitation severity of delirium were evaluated retrospectively. Multivariate ordered logistic regression analysis was performed to identify predictive factors. RESULTS: Male sex [odds ratio (OR)=2.125, 95% confidence interval (CI)=1.111-4.067; P=0.0227]; total bilirubin (T-bil) [OR=1.557, CI=1.082-2.239; P=0.017]; antibiotics [OR=0.450, CI=0.219-0.925; P=0.0298]; nonsteroidal antiinflammatory drugs (NSAIDs) [OR=2.608, CI=1.374-4.950; P=0.0034]; and hematological malignancy [OR=3.903, CI=1.363-11.179; P=0.0112] were found to be statistically significant predictors for agitation severity of hyperactive delirium. CONCLUSIONS: Our study indicates that male sex, T-bil, antibiotic therapy, NSAID therapy, and hematological malignancy are significant predictors for agitation severity of hyperactive delirium in terminally ill cancer patients in a general hospital setting.