Associations between postoperative cognitive dysfunction, serum interleukin‐6 and postoperative delirium among patients after coronary artery bypass grafting: A mediation analysis

• Published in: Nursing in critical care 2024-11, Vol.29 (6), p.1245-1252
• Main Authors: Zhang, Shan, Tao, Xiang‐jun, Ding, Shu, Feng, Xin‐wei, Wu, Fang‐qin, Wu, Ying
• Format: Article
• Language: English
• Subjects: Aged; cardiac surgery; Clinical medicine; Cognitive Dysfunction - blood; Cognitive Dysfunction - etiology; Coronary Artery Bypass - adverse effects; Coronary vessels; Cytokines; Delirium; Delirium - blood; Delirium - etiology; delirium assessment and management; early recognition; Female; Humans; Interleukin-6 - blood; Male; Middle Aged; Postoperative Cognitive Complications - blood; Postoperative Complications - blood; Postoperative Complications - epidemiology; Prospective Studies; Regression analysis; Risk Factors; survey design
• ISSN: 1362-1017; 1478-5153; 1478-5153
• DOI: 10.1111/nicc.13081

Background POCD is a common complication among patients who underwent coronary artery bypass graft (CABG), it is linked to loss of independence and reduced quality of life. Aim To examine the association between postoperative cognitive dysfunction (POCD), postoperative delirium (POD) and interleukin‐6 (IL‐6). Design A prospective cohort study. Methods Patients who underwent elective isolated CABG were enrolled. POCD was assessed by a set of cognitive function tools. Delirium was assessed using the CAM‐ICU. The logistic regression analyses were used to identify the predictive value of POD or IL‐6 on POCD. The path analysis was used to analyse the relationship among POD, IL‐6 and POCD. Results A total of 212 patients were enrolled, with 25.0% of patients developing POD and 32.5% developing POCD. The multiple logistic regression analysis revealed that patients with POD had a four‐fold increased hazard of POCD (OR = 3.655), and patients with IL‐6 ≥ 830.50 pg/mL at the 6th hours after surgery had a 5‐fold increased risk of experiencing POCD (OR = 5.042). However, the mediation effect of POD between IL‐6 and POCD was not statistically significant (β = 0.059, p = .392). Conclusions POD and IL‐6 at the 6th hour after surgery (≥830.50 pg/mL) are two potent predictors for POCD, while POD did not play a mediation effect between IL‐6 and POCD. Relevance to Clinical Practice Early identification of risk factors (e.g., delirium assessment and testing for serum IL‐6 levels) by clinical nurses for POCD may contribute to the clinical practice for the targeted prevention nursing strategies.