Purpose: Post-operative delirium (POD) is a common complication after aortic surgery with poor outcomes. Blood pressure may play a role in the occurrence of POD. The study aimed to identify whether admission systolic blood pressure (SBP) level in the intensive care unit (ICU) is correlated with POD in acute Stanford type A aortic dissection (AAAD) patients undergoing aortic surgery.
Patients and Methods: We conducted a single-center retrospective cohort study enrolling consecutive 205 patients with acute type A aortic dissection undergoing aortic surgery. Patients were divided into 3 groups: low, normal, and high SBP level group. Outcomes of interest were POD, 30-day mortality and other complications including acute kidney injury, cardiac complications, spinal cord ischemia, stroke, and pneumonia. Confusion Assessment Method for Intensive Care Unit (CAM-ICU) method was used to assess POD. Univariate and multivariate logistic regression, Cox regression, and subgroup analysis were performed to uncover the association between SBP and POD.
Results: The mean age of these patients was 51± 16 years old. Thirty-six patients (17.6%) developed POD. Patients with high admission SBP were more likely to develop POD (P < 0.01). Univariate analysis showed that high admission SBP was associated with a higher risk of POD among AAAD patients (OR, 3.514; 95% CI, 1.478– 8.537, P < 0.01). Multivariate logistic regression model confirmed that high SBP was an independent predictor of POD. Subgroup analysis indicated that patients with anemia and high admission SBP were at higher risk of POD.
Conclusion: High admission SBP was positively associated with the incidence of POD in AAAD patients who underwent surgical repair in ICU.

Keywords: acute Stanford type A aortic dissection, intensive care unit, major surgery, post-operative delirium, systolic blood pressure


中文翻译：

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入院收缩压预测重症监护病房急性主动脉夹层患者术后谵妄

目的：术后谵妄（POD）是主动脉手术后常见的并发症，预后不佳。血压可能在POD的发生中起作用。该研究旨在确定重症监护病房 (ICU) 入院收缩压 (SBP) 水平是否与接受主动脉手术的急性斯坦福 A 型主动脉夹层 (AAAD) 患者的 POD 相关。
患者和方法：我们进行了一项单中心回顾性队列研究，连续招募了 205 名接受主动脉手术的急性 A 型主动脉夹层患者。将患者分为3组：低SBP水平组、正常组和高SBP水平组。感兴趣的结果是 POD、30 天死亡率和其他并发症，包括急性肾损伤、心脏并发症、脊髓缺血、中风和肺炎。重症监护病房（CAM-ICU）方法的混乱评估方法用于评估POD。进行单变量和多变量逻辑回归、Cox 回归和亚组分析以揭示 SBP 和 POD 之间的关联。
结果：这些患者的平均年龄为 51±16 岁。36 名患者 (17.6%) 发展为 POD。入院 SBP 高的患者更容易发生 POD（P < 0.01）。单变量分析显示，AAAD 患者入院时 SBP 高与 POD 风险较高相关（OR，3.514；95% CI，1.478-8.537，P < 0.01）。多元逻辑回归模型证实高 SBP 是 POD 的独立预测因子。亚组分析表明，患有贫血和高入院 SBP 的患者发生 POD 的风险更高。
结论：高入院 SBP 与在 ICU 接受手术修复的 AAAD 患者的 POD 发生率呈正相关。

关键词：急性斯坦福A型主动脉夹层，重症监护室，大手术，术后谵妄，收缩压