Association Between Hypernatremia and Delirium After Cardiac Surgery: A Nested Case-Control Study

Liang Hong; Xiao Shen; Qiankun Shi; Xiaochun Song; Lihai Chen; Wenxiu Chen; Shangyu Chen; Yingyin Xue; Cui Zhang; Jifang Zhou

doi:10.3389/fcvm.2022.828015

Association Between Hypernatremia and Delirium After Cardiac Surgery: A Nested Case-Control Study

Front Cardiovasc Med. 2022 Mar 8:9:828015. doi: 10.3389/fcvm.2022.828015. eCollection 2022.

Authors

Affiliations

¹ Department of Intensive Care Unit, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
² Department of Anesthesia, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
³ School of International Business, China Pharmaceutical University, Nanjing, China.

Abstract

Background: The association between hypernatremia and delirium after cardiac surgery has rarely been investigated. This study aimed to determine whether hypernatremia increases the risk of delirium after exposure.

Materials and methods: From April 2016 to June 2021, 7,831 consecutive patients receiving cardiac surgery were screened for potential enrollment. The primary outcome was postoperative delirium (POD). For the respective case of delirium, 10 controls were matched according to the index date within the nested case-control design. Hypernatremia exposure was defined as serum sodium > 145 mmol/L within 7 days before the index date. A generalized estimation equation was performed to assess excess risks for POD associated with hypernatremia, adjusted for demographics and clinical variables.

Results: About 7,277 patients were included in the final analyses. About 669 (9.2%) patients with POD were assigned to the case group, and 6,690 controls were identified from the whole population. About 66.5% of the cases and 36.3% of the controls had hypernatremia exposure. After being adjusted to certain well-recognized confounding factors, hypernatremia showed a significant correlation with increased risk of delirium after cardiac surgery (adjusted OR, 1.73; 95% CI, 1.41~2.12). An e-value analysis suggested the robustness to unmeasured confounding.

Conclusions: Hypernatremia was associated with an increased risk of delirium after cardiac surgery. This finding could have implications for risk stratification, early detection, and management of delirium in patients receiving cardiac surgery.

Keywords: cardiac surgery; delirium; hypernatremia; nested case-control; risk factors.