Delirium Could Indicate Onset of Sepsis in Cardiac Bypass Patients

A new study claims that delirium is a strong predictor of sepsis and mortality after coronary artery bypass graft (CABG) surgery.

Researchers at Dalhousie University (Halifax, NS, Canada) conducted a prospective observational study of 14,301 patients who underwent CABG. Delirium for the purpose of the study was defined as "a short-term mental disturbance marked by confusion, illusions, and cerebral excitement.” The researchers found that a total of 981 patients (6.9%) developed delirium and 246 patients developed sepsis following CABG surgery. Predictors of postoperative sepsis in addition to delirium were preoperative length of stay exceeding 7 days, advanced age, diabetes, preoperative renal failure, peripheral vascular disease, and severe disease. The researchers also found that the percentage rates of delirium increased during the years of the study, from 4.8% in 1998 to 8.0% in 2007. The study was presented at the Society of Critical Care Medicine (SCCM) 38th Critical Care Congress, held during February 2009 in Nashville (TN, USA).

"In 75% of patients, delirium preceded sepsis,” said lead author and study presenter Billie Jean Martin, M.D., of the division of cardiac surgery. "An increase in agitation may be a very early sign of infection. It tends to precede overt infection by about 2 days... and it is a risk factor for mortality.”

"Patients who are delirious or agitated are more likely to pull out their central venous lines, aggravating the problem,” added Dr. Martin. "Venous lines are common sites of infection, especially with frequent reinsertion.”

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