Vitamin D and Postoperative Delirium After Coronary Artery Bypass Grafting: A Prospective Cohort Study

Velayati, Aynaz; Shariatpanahi, Zahra Vahdat; Dehghan, Salman; Zayeri, Farid

doi:10.1053/j.jvca.2020.02.008

Cited by 19 publications

(14 citation statements)

References 26 publications

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“…22 A recent prospective study of 398 patients by Aynaz and colleagues showed that preoperative severe vitamin D deficiency was associated with postoperative delirium (OR = 3.18, Confidence interval: 1.3-7.8) after coronary artery bypass surgery. 16 We similarly observed a relationship between preoperative vitamin D and new-onset delirium in non-cardiac and non-neurosurgical patients. Our results support the theory that since an association between vitamin D and delirium is validated, and vitamin D status also is highly amenable with supplementation—Therefore, adequate vitamin D concentrations may protect against delirium in surgical patients.…”

Section: Discussionsupporting

confidence: 52%

“…14 A prospective cohort study of 398 patients similarly concludes that severe preoperative vitamin D deficiency is associated with postoperative delirium after coronary artery bypass grafting surgery. 16 It nonetheless remains unknown whether preoperative vitamin D deficiency increases the risk of delirium after noncardiac surgery. We therefore tested the primary hypothesis that preoperative vitamin D deficiency is associated with delirium in non-cardiac surgical ICU patients.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Preoperative Vitamin D Deficiency Is Associated With Postoperative Delirium in Critically Ill Patients

Qiu

Sessler

Liang

et al. 2021

J Intensive Care Med

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Introduction: Postoperative delirium is common, with a reported incidence of 11% to 80% in critically ill patients. Delirium is an independent prognostic factor for poor hospital outcomes. Low vitamin D concentrations are associated with a decline in cognitive function. We therefore tested the hypothesis that low preoperative serum 25-hydroxyvitamin D [25(OH)D] concentrations are associated with postoperative delirium in critically ill patients. Method: We conducted a retrospective analysis of adults in a surgical intensive care unit for at least 48 hours immediately after non-cardiac and non-neurosurgical operations at Cleveland Clinic between 2013 and 2018. Delirium was assessed by trained nurses using CAM-ICU twice daily for the initial 5 postoperative days. Any positive value was considered evidence of delirium. We assessed the association between 25(OH)D concentrations within a year before surgery and the incidence of postoperative delirium using logistic regression, adjusted for potential confounders. A linear spline term with a knot at 30 ng/ml, the threshold for normal 25(OH)D concentration, was added to accommodate a nonlinear relationship between 25(OH)D concentrations and delirium. Results: We included 632 patients, who had a mean (SD) 25(OH)D concentration of 25 (15) ng/ml; 55% (346/632) experienced delirium. We observed an adjusted odds ratio of 1.4 (95% CI: [1.1, 1.8], P = 0.01) for delirium per 10 ng/ml decrease in 25(OH)D concentrations when patients’ 25(OH)D concentrations were less than 30 ng/ml. In patients whose 25(OH)D concentrations were at least 30 ng/ml, the adjusted odds ratio was 0.9 (95% CI: [0.7, 1.1], P = 0.36). Conclusion: Preoperative 25(OH)D concentrations are associated with postoperative delirium in patients whose concentrations are below the normal threshold, but not at concentrations ≥30 ng/ml. A trial will be needed to determine whether the relationship is causal, and whether vitamin D supplementation before surgery might reduce the incidence of delirium.

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Section: Discussionsupporting

confidence: 52%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Preoperative Vitamin D Deficiency Is Associated With Postoperative Delirium in Critically Ill Patients

Qiu

Sessler

Liang

et al. 2021

J Intensive Care Med

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“…3 In this issue of the Journal of Cardiothoracic and Vascular Anesthesia, Velayati et al explore the association of preoperative vitamin D deficiency and the incidence of postoperative delirium after coronary artery bypass graft surgery. 4 Vitamin D is a steroid prohormone that is best known for its role in calcium homeostasis and maintaining bone integrity but recently has received attention for its other biological effects. 5 Vitamin D deficiency, defined as inadequate serum levels of vitamin D below 30 ng/mL, is estimated to affect about 1 billion individuals worldwide, nearly 1 in 2 older adults (ie, age 65 y) and 70% to 90% of adults with cognitive difficulties.…”

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confidence: 99%

“…Patients with delirium also were older than the nondelirious patients (65.6 § 10.2 y v 60 § 8.7 y) and had a longer length of stay in the ICU and duration of hospital stay. 4 It is difficult to separate the risk of postoperative delirium related to older age versus lower serum vitamin D levels. It is possible that these 2 covariates are intimately related.…”

mentioning

confidence: 99%