Dynamic Predictive Scores for Cardiac Surgery-Associated Agitated Delirium: a single-center retrospective observational study

Abstract

Background Prevention, screening, and early treatment are the mainstays of postoperative delirium management. Score system is an objective and effective tool to stratify potential delirium risk for patients undergoing cardiac surgery Methods Patients undergoing cardiac surgery from January 1, 2012, to January 1, 2019, were enrolled in our retrospective study. The patients were divided into a derivation cohort (n = 45,744) and a validation cohort (n = 11,436). The agitated delirium (AD) predictive systems were formulated using multivariate logistic regression analysis at three time points: preoperation, ICU admittance, and 24 hours after ICU admittance. Results The prevalence of AD after cardiac surgery in the whole cohort was 3.6% (2,085/57,180). The dynamic scoring system included preoperative LVEF ≤ 45%, serum creatinine > 100 umol/L, emergency surgery, coronary artery disease, hemorrhage volume > 600 mL, intraoperative platelet or plasma use, and postoperative LVEF ≤ 45%. The area under the receiver operating characteristic curve (AUC) values for AD prediction of 0.68 (preoperative), 0.74 (on the day of ICU admission), and 0.75 (postoperative). The Hosmer-Lemeshow test indicated that the calibration of the preoperative prediction model was poor (P = 0.01), whereas that of the pre- and intraoperative prediction model (P = 0.49) and the pre-, intra- and postoperative prediction model (P = 0.35) was good. Conclusions Using perioperative data, we developed a dynamic scoring system for predicting the risk of AD following cardiac surgery. The dynamic scoring system may improve early recognition of and interventions for AD.