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

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 p...

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Autores principales: Saller, Thomas, Peterss, Sven, Scheiermann, Patrick, Eser-Valeri, Daniela, Ehler, Johannes, Bruegger, Dirk, Chappell, Daniel, Kofler, Othmar, Hagl, Christian, Hofmann-Kiefer, Klaus
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7353880/
https://www.ncbi.nlm.nih.gov/pubmed/32471143
http://dx.doi.org/10.3390/medicina56060258
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author Saller, Thomas
Peterss, Sven
Scheiermann, Patrick
Eser-Valeri, Daniela
Ehler, Johannes
Bruegger, Dirk
Chappell, Daniel
Kofler, Othmar
Hagl, Christian
Hofmann-Kiefer, Klaus
author_facet Saller, Thomas
Peterss, Sven
Scheiermann, Patrick
Eser-Valeri, Daniela
Ehler, Johannes
Bruegger, Dirk
Chappell, Daniel
Kofler, Othmar
Hagl, Christian
Hofmann-Kiefer, Klaus
author_sort Saller, Thomas
collection PubMed
description 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.
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spelling pubmed-73538802020-07-21 Natriuretic Peptides as a Prognostic Marker for Delirium in Cardiac Surgery—A Pilot Study Saller, Thomas Peterss, Sven Scheiermann, Patrick Eser-Valeri, Daniela Ehler, Johannes Bruegger, Dirk Chappell, Daniel Kofler, Othmar Hagl, Christian Hofmann-Kiefer, Klaus Medicina (Kaunas) Article 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. MDPI 2020-05-27 /pmc/articles/PMC7353880/ /pubmed/32471143 http://dx.doi.org/10.3390/medicina56060258 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Saller, Thomas
Peterss, Sven
Scheiermann, Patrick
Eser-Valeri, Daniela
Ehler, Johannes
Bruegger, Dirk
Chappell, Daniel
Kofler, Othmar
Hagl, Christian
Hofmann-Kiefer, Klaus
Natriuretic Peptides as a Prognostic Marker for Delirium in Cardiac Surgery—A Pilot Study
title Natriuretic Peptides as a Prognostic Marker for Delirium in Cardiac Surgery—A Pilot Study
title_full Natriuretic Peptides as a Prognostic Marker for Delirium in Cardiac Surgery—A Pilot Study
title_fullStr Natriuretic Peptides as a Prognostic Marker for Delirium in Cardiac Surgery—A Pilot Study
title_full_unstemmed Natriuretic Peptides as a Prognostic Marker for Delirium in Cardiac Surgery—A Pilot Study
title_short Natriuretic Peptides as a Prognostic Marker for Delirium in Cardiac Surgery—A Pilot Study
title_sort natriuretic peptides as a prognostic marker for delirium in cardiac surgery—a pilot study
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7353880/
https://www.ncbi.nlm.nih.gov/pubmed/32471143
http://dx.doi.org/10.3390/medicina56060258
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