Prediction of Postoperative Delirium After Cardiac Surgery with A Quick Test of Cognitive Speed, Mini-Mental State Examination and Hospital Anxiety and Depression Scale
(2022) In Clinical Interventions in Aging 17. p.359-368- Abstract
Purpose: To evaluate if preoperative assessment with A Quick Test of Cognitive Speed (AQT) could increase the accuracy of predicting delirium after cardiac surgery compared to Mini-Mental State Examination (MMSE), and examine if a composite of variables, including cognitive function and depressive symptoms, could be useful to predict delirium. Patients and Methods: Cardiac surgery was performed in 218 patients (mean age 72 years). Preoperative evaluation involved AQT, MMSE and Hospital Anxiety And Depression Scale (HADS). Postoperative delirium was assessed using Nursing Delirium Screening Scale (Nu-DESC) and Confusion Assessment Method-ICU (CAM-ICU). Logistic regression was performed to detect predictors of postoperative delirium and... (More)
Purpose: To evaluate if preoperative assessment with A Quick Test of Cognitive Speed (AQT) could increase the accuracy of predicting delirium after cardiac surgery compared to Mini-Mental State Examination (MMSE), and examine if a composite of variables, including cognitive function and depressive symptoms, could be useful to predict delirium. Patients and Methods: Cardiac surgery was performed in 218 patients (mean age 72 years). Preoperative evaluation involved AQT, MMSE and Hospital Anxiety And Depression Scale (HADS). Postoperative delirium was assessed using Nursing Delirium Screening Scale (Nu-DESC) and Confusion Assessment Method-ICU (CAM-ICU). Logistic regression was performed to detect predictors of postoperative delirium and receiver operator characteristic curves (ROC) with area under the curve (AUC) to determine the accuracy. Results: Postoperative delirium occurred in 47 patients (22%) who had lower MMSE scores (median (range), 27 (19–30) vs 28 (20– 30), p=0.009) and slower AQT (median (range), 76 (48–181) vs 70 (40–182) seconds, p=0.030) than patients without delirium. Predictive power measured as AUC (95% CI) was 0.605 (0.51–0.70) for AQT and 0.623 (0.53–0.72) for MMSE. Logistic regression (OR, 95% CI) showed MMSE <27 points (2.72, 1.27–5.86), AQT >70 sec (2.26, 1.03–4.95), HADS-D >4 points (2.60, 1.21–5.58) and longer cardiopulmonary bypass-time (1.007, 1.002–1.013) to be associated with postoperative delirium. Combining these parameters yielded an AUC of 0.736 (0.65–0.82). Conclusion: The ability of predicting delirium using AQT was similar to MMSE, and only slightly higher by combining AQT and MMSE. Adding HADS-D and cardiopulmonary bypass-time to MMSE and AQT increased the predictive power to a borderline acceptable discriminatory value. Preoperative cognitive tests and screening for depressive symptoms may help identify patients at risk of postoperative delirium. Yet, there is still a need to establish useful preoperative tests.
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- author
- Segernäs, Anna ; Skoog, Johan ; Andersson, Eva Ahlgren ; Österberg, Sofia Almerud ; Thulesius, Hans LU and Zachrisson, Helene
- organization
- publishing date
- 2022
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- A Quick Test of Cognitive Speed, cardiopulmonary bypass, Mini Mental State Examination, postoperative delirium, The Hospital Anxiety and Depression Scale
- in
- Clinical Interventions in Aging
- volume
- 17
- pages
- 10 pages
- publisher
- Dove Medical Press Ltd.
- external identifiers
-
- pmid:35400995
- scopus:85127860325
- ISSN
- 1176-9092
- DOI
- 10.2147/CIA.S350195
- language
- English
- LU publication?
- yes
- additional info
- Funding Information: This work was supported by grants from the Medical Research Council of Southeast Sweden (FORSS start grant 389071 and grant FORSS 660611) and the Region Kronoberg Research Council (grant 4967). The funders did not have any impact in the design of the study and collection, analysis and interpretation of the data or in writing the manuscript. Publisher Copyright: © 2022Segernäs et al.
- id
- 68e01239-a7f8-41d5-9deb-77b18799831d
- date added to LUP
- 2022-06-10 11:55:04
- date last changed
- 2024-06-27 18:49:49
@article{68e01239-a7f8-41d5-9deb-77b18799831d,
abstract = {{<p>Purpose: To evaluate if preoperative assessment with A Quick Test of Cognitive Speed (AQT) could increase the accuracy of predicting delirium after cardiac surgery compared to Mini-Mental State Examination (MMSE), and examine if a composite of variables, including cognitive function and depressive symptoms, could be useful to predict delirium. Patients and Methods: Cardiac surgery was performed in 218 patients (mean age 72 years). Preoperative evaluation involved AQT, MMSE and Hospital Anxiety And Depression Scale (HADS). Postoperative delirium was assessed using Nursing Delirium Screening Scale (Nu-DESC) and Confusion Assessment Method-ICU (CAM-ICU). Logistic regression was performed to detect predictors of postoperative delirium and receiver operator characteristic curves (ROC) with area under the curve (AUC) to determine the accuracy. Results: Postoperative delirium occurred in 47 patients (22%) who had lower MMSE scores (median (range), 27 (19–30) vs 28 (20– 30), p=0.009) and slower AQT (median (range), 76 (48–181) vs 70 (40–182) seconds, p=0.030) than patients without delirium. Predictive power measured as AUC (95% CI) was 0.605 (0.51–0.70) for AQT and 0.623 (0.53–0.72) for MMSE. Logistic regression (OR, 95% CI) showed MMSE <27 points (2.72, 1.27–5.86), AQT >70 sec (2.26, 1.03–4.95), HADS-D >4 points (2.60, 1.21–5.58) and longer cardiopulmonary bypass-time (1.007, 1.002–1.013) to be associated with postoperative delirium. Combining these parameters yielded an AUC of 0.736 (0.65–0.82). Conclusion: The ability of predicting delirium using AQT was similar to MMSE, and only slightly higher by combining AQT and MMSE. Adding HADS-D and cardiopulmonary bypass-time to MMSE and AQT increased the predictive power to a borderline acceptable discriminatory value. Preoperative cognitive tests and screening for depressive symptoms may help identify patients at risk of postoperative delirium. Yet, there is still a need to establish useful preoperative tests.</p>}},
author = {{Segernäs, Anna and Skoog, Johan and Andersson, Eva Ahlgren and Österberg, Sofia Almerud and Thulesius, Hans and Zachrisson, Helene}},
issn = {{1176-9092}},
keywords = {{A Quick Test of Cognitive Speed; cardiopulmonary bypass; Mini Mental State Examination; postoperative delirium; The Hospital Anxiety and Depression Scale}},
language = {{eng}},
pages = {{359--368}},
publisher = {{Dove Medical Press Ltd.}},
series = {{Clinical Interventions in Aging}},
title = {{Prediction of Postoperative Delirium After Cardiac Surgery with A Quick Test of Cognitive Speed, Mini-Mental State Examination and Hospital Anxiety and Depression Scale}},
url = {{http://dx.doi.org/10.2147/CIA.S350195}},
doi = {{10.2147/CIA.S350195}},
volume = {{17}},
year = {{2022}},
}