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Sepsis Associated Delirium
Open AccessArticle

Natriuretic Peptides as a Prognostic Marker for Delirium in Cardiac Surgery—A Pilot Study

1
Department of Anaesthesiology, University Hospital, LMU Munich, 81377 Munich, Germany
2
Department of Cardiac Surgery, University Hospital, LMU Munich, 81377 Munich, Germany
3
Department of Psychiatry, University Hospital, LMU Munich, 80336 Munich, Germany
4
Department of Anaesthesiology and Intensive Care Medicine, University Medical Center, 18057 Rostock, Germany
5
Clinic for Anaesthesia, Surgical Intensive Care, Emergency Medicine and Pain Therapy, Klinikum Frankfurt Hoechst, 65929 Frankfurt/Main, Germany
*
Author to whom correspondence should be addressed.
Medicina 2020, 56(6), 258; https://doi.org/10.3390/medicina56060258
Received: 12 April 2020 / Revised: 19 May 2020 / Accepted: 22 May 2020 / Published: 27 May 2020
(This article belongs to the Special Issue Delirium in Critically Ill Patients)
Background and Objectives: Delirium is a common and major complication subsequent to cardiac surgery. Despite scientific efforts, there are no parameters which reliably predict postoperative delirium. In delirium pathology, natriuretic peptides (NPs) interfere with the blood–brain barrier and thus promote delirium. Therefore, we aimed to assess whether NPs may predict postoperative delirium and long-term outcomes. Materials and Methods: To evaluate the predictive value of NPs for delirium we retrospectively analyzed data from a prospective, randomized study for serum levels of atrial natriuretic peptide (ANP) and the precursor of C-type natriuretic peptide (NT-proCNP) in patients undergoing coronary artery bypass grafting (CABG) with or without cardiopulmonary bypass (off-pump coronary bypass grafting; OPCAB). Delirium was assessed by a validated chart-based method. Long-term outcomes were assessed 10 years after surgery by a telephone interview. Results: The overall incidence of delirium in the total cohort was 48% regardless of the surgical approach (CABG vs. OPCAB). Serum ANP levels > 64.6 pg/mL predicted delirium with a sensitivity (95% confidence interval) of 100% (75.3–100) and specificity of 42.9% (17.7–71.1). Serum NT-proCNP levels >1.7 pg/mL predicted delirium with a sensitivity (95% confidence interval) of 92.3% (64.0–99.8) and specificity of 42.9% (17.7–71.1). Both NPs could not predict postoperative survival or long-term cognitive decline. Conclusions: We found a positive correlation between delirium and preoperative plasma levels of ANP and NT-proCNP. A well-powered and prospective study might identify NPs as biomarkers indicating the risk of delirium and postoperative cognitive decline in patients at risk for postoperative delirium. View Full-Text
Keywords: delirium; cardiac surgery; off-pump surgery; natriuretic peptide; biomarker delirium; cardiac surgery; off-pump surgery; natriuretic peptide; biomarker
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Saller, T.; Peterss, S.; Scheiermann, P.; Eser-Valeri, D.; Ehler, J.; Bruegger, D.; Chappell, D.; Kofler, O.; Hagl, C.; Hofmann-Kiefer, K. Natriuretic Peptides as a Prognostic Marker for Delirium in Cardiac Surgery—A Pilot Study. Medicina 2020, 56, 258.

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