Previous studies have shown a relationship between delirium and depressive symptoms after cardiac surgery with distress personalities linking to negative surgical outcomes. The aim of the present study is to further investigate the association between patients with Type D (distressed) personality with regards to delirium after cardiac surgery. We conducted a consecutive-sample observational cohort pilot study with an estimated 142 patients needed. Enrollment criteria included patients aged ≥18 years who were undergoing planned cardiovascular, thoracic and abdominal artery surgery between October 2015 to August 2016 at the University of Tsukuba Hospital, Japan. All patients were screened by Type-D Personality Scale-14 (DS14) as well as the Hospital Anxiety and Depression Scale (HADS) the day before surgery. Following surgery, daily data was collected during recovery and included severity of organ dysfunction, sedative/analgesic exposure and other relevant information. We then evaluated the association between Type D personality and delirium/coma days (DCDs) during the 7-day study period. We applied regression and mediation modeling for this study. A total of 142 patients were enrolled in the present study and the total prevalence of delirium was found to be 34% and 26% of the patients were Type D. Non-Type D personality patients experienced an average of 1.3 DCDs during the week after surgery while Type D patients experienced 2.1 days over the week after surgery. Multivariate analysis showed that Type D personality was significantly associated with increased DCDs (OR:2.8, 95%CI:1.3–6.1) after adjustment for depressive symptoms and clinical variables. Additionally, there was a significant Type D x depression interaction effect (OR:1.7, 95% CI:1.2–2.2), and depressive symptoms were associated with DCDs in Type D patients, but not in non-Type D patients. Mediation modeling showed that depressive symptoms partially mediated the association of Type D personality with DCDs (Aroian test =0.04). Type D personality is a prognostic predictor for prolonged acute brain dysfunction (delirium/coma) in cardiovascular patients independent from depressive symptoms and Type D personality-associated depressive symptoms increase the magnitude of acute brain dysfunction.

中文翻译：

---

D型人格是心血管手术后长期急性脑功能障碍（del妄/昏迷）的预测指标

先前的研究表明cardiac妄与心脏手术后的抑郁症状之间的关系与困扰人格与不良的手术结局有关。本研究的目的是进一步研究心脏手术后D妄的D型（困扰）人格患者之间的关联。我们进行了一项连续样本的观察性队列先导研究，估计需要142名患者。入选标准包括在2015年10月至2016年8月之间在日本筑波大学医院进行的计划内的心血管，胸腔和腹部动脉手术的≥18岁患者。在手术前一天，通过D型人格量表14（DS14）以及医院焦虑和抑郁量表（HADS）对所有患者进行筛查。手术后 恢复期间收集的每日数据包括器官功能障碍的严重程度，镇静/止痛药的暴露以及其他相关信息。然后，我们在7天的研究期内评估了D型人格与del妄/昏迷天数（DCD）之间的关联。我们在本研究中应用了回归和中介模型。本研究共纳入142例患者，发现ir妄的总患病率为34％，其中26％为D型。非D型人格患者在术后一周平均经历1.3次DCD D型患者术后一周要经历2.1天。多变量分析显示，在调整了抑郁症状和临床变量后，D型人格与DCD升高显着相关（OR：2.8，95％CI：1.3–6.1）。此外，D型与抑郁症有显着的交互作用（OR：1.7，95％CI：1.2–2.2），且抑郁症状与DD患者相关，而非D型患者则与DCD相关。中介模型显示，抑郁症状部分介导了D型人格与DCD的关联（Aroian检验= 0.04）。D型人格是与抑郁症状无关的心血管患者长期急性脑功能障碍（（妄/昏迷）的预后指标，而D型人格相关的抑郁症状会增加急性脑功能障碍的程度。中介模型显示，抑郁症状部分介导了D型人格与DCD的关联（Aroian检验= 0.04）。D型人格是与抑郁症状无关的心血管患者长期急性脑功能障碍（（妄/昏迷）的预后指标，而D型人格相关的抑郁症状会增加急性脑功能障碍的程度。中介模型显示，抑郁症状部分介导了D型人格与DCD的关联（Aroian检验= 0.04）。D型人格是与抑郁症状无关的心血管患者长期急性脑功能障碍（（妄/昏迷）的预后指标，而D型人格相关的抑郁症状会增加急性脑功能障碍的程度。