- Email: [email protected]
P-169: Relation between S100B and delirium remains controversial
Poster presentations / European Geriatric Medicine 6S1 (2015) S32–S156
no difference in pre-operative CSF S100B levels between delirious and non-delirious patients (median: 1053 pg/mL, inter-quartile range (IQR): 601–1178 versus median: 862 pg/mL, IQR: 701– 1156, p = 0.760). The two patients with pre-operative delirium seemed to have higher S100B levels (1052 pg/mL and 2258 pg/mL) than patients with post-operative or no delirium (median: 848 pg/mL, IQR: 595–1177 and median 862 pg/mL, IQR: 701–1156, respectively). Conclusion: Pre-operative CSF S100B levels did not differ between patients with and without delirium. The higher S100B levels in two patients with delirium at the time of CSF sampling suggest that timing is important in determining the association between delirium and S100B. P-169 Relation between S100B and delirium remains controversial S. Beishuizen Academical Medical Centre, Amsterdam, Netherlands Objectives: Delirium is associated with subsequent increased risk of dementia. This may reflect actual brain damage that arises during a delirious episode. Several studies suggest that S100B, a marker of brain damage, is elevated during delirium. We aim to assess the association between serum S100B levels and delirium in order to further elucidate the pathophysiology of delirium. Methods: This was a prospective cohort study including patients aged 65 years and older who were admitted for surgical repair of a hip fracture. Delirium was diagnosed using the Confusion Assessment Method (CAM). A maximum of four serum samples were obtained per patient during admission. S100B was measured using enzyme-linked immunosorbent assay. Results: 995 samples of 385 patients, aged 65–102 years old, were analyzed. 226 patients (59%) had prior cognitive impairment. Cognitive impaired patients were older (86.3 vs. 80.6 years old, p < 0.001), had more functional impairments (Katz-ADL-score 9 vs. 2, p < 0.001) and more often experienced delirium (44.7% vs. 16.4%, p < 0.001). Comparing the first samples during delirium to samples of non-delirious patients, no difference in S100B level was observed (median 0.09 mcg/L versus 0.08 mcg/L, p = 0.219). Multilevel analysis, adjusted for age, prior cognitive impairment, surgery and infection showed no association between S100B level and delirium (p = 0.32). However, surgery (Beta 0.029, p < 0.001), infection (Beta 0.013, p = 0.04) and older age (Beta 0.001, p = 0.01) were associated with increased S100B levels. Conclusion: In our cohort of older hip fracture patients, we found no association between S100B levels and delirium. The relation between S100B and delirium therefore remains controversial.
S77
Aarhus University Hospital. There were 179 patients included in the study. The first day of hospitalization all enrolled patients were examined for cognitive impairment (assessed by the Mini Mental State Examination) and delirium (assessed by Confusion Assessment Method). Delirium was also assessed on the 10th postoperative day. Results: The prevalence of delirium was 11% in patients allocated to a liberal blood transfusion threshold (LB) and 22% in the group with a restrictive transfusion threshold (RB). There was association between LB and RB and development of delirium day 10th, OR 0.41 (95% CI: 0.17–0.96), p = 0.04. Delirium on day 10th increased the probability of 90-day mortality OR 2.91 (95% CI: 1.28–6.64), p = 0.01. Conclusion: In nursing home residents, a maintained hemoglobin level above 11.3 g/dL does reduce the probability of developing postoperative delirium day 10th compared with a restrictive transfusion strategy. Development of postoperative delirium increases the probability of mortality. P-171 Delirium within the first week of stroke – a pilot study M. Buckley1 , M. Ramjee2 , R. Coary2 , A. Fallon3 , S.P. Kennelly3 Age Related Healthcare, Adelaide and Meath hospital, Dublin, Ireland; 2 ARHC, Adelaide and Meath Hospital, Tallaght, Ireland; 3 Tallaght Hospital, Dublin, Ireland
1
P-170 Blood transfusion strategy and risk of postoperative delirium in nursing homes residents with hip fracture
Objectives: Delirium is common in acute stroke. Studies indicate prevalence ranges from 13–48%. The purpose of this study is to assess the prevalence of delirium in the first week of stroke and to determine risk factors for the development of delirium. Methods: Patients admitted to our Acute Stroke Unit were included. Underlying cognitive impairment was assessed using AD8 questionnaire. Delirium screen comprising of 6CIT and DRS was undertaken daily for the first 7 days of admission and data was collected to assess for potential causes of a delirium. Results: 34 people have been recruited to date with an average age of 67.9 years. 17.6% of patients (n= 6) had a previous diagnosis of dementia. 20.6% (n = 7) were diagnosed with delirium during the first week of stroke. Average age of these patients was 65 (range 40–79). 2 of these patients had a history of dementia. 28.6% (n = 2) had large haemorrhagic TACS and were under the age of 50. 42.8% (n = 3) had an ischaemic PACS and 28.6% had ischaemic POCS. 2 were on intravenous antibiotic therapy and 2 had documented constipation. The median time for patients to be transferred to the Acute Stroke Unit was 23 hours. In the group who developed delirium, median time to transfer was 48 hrs. Conclusions: Data collection is currently ongoing. Our results to date suggest that delirium occurs in 20% of our patients. Partial anterior circulation stroke syndromes were most likely to become delirious, although this group had 2 patients with dementia.
S. Blandfort1 , E.M. Damsgaard2 , M. Gregersen2 Departments of Geriatrics, Aarhus University Hospital, Aarhus C., Denmark; 2 Department of Geriatrics, Aarhus University Hospital, Aarhus C, Denmark
P-172 Can the development of delirium predict cognitive function after aortic valve implantation?
1
Objectives: To investigate whether a liberal blood transfusion strategy (Hb levels ≥11.3 g/dL (7 mmol/L)) reduces the risk of postoperative delirium day 10th in nursing homes residents with hip fracture, compared with a restrictive transfusion strategy (Hb levels ≥9.7 g/dL (6 mmol/L)). Furthermore, to investigate whether postoperative delirium increases mortality within 90 days after hip surgery. Methods: A post-hoc analysis based on The TRIFE randomized controlled trail. Consecutive recruitment of frail anemic patients (aged ≥65 years), residing in nursing homes suffering from unilateral hip fracture, in the period from January 18 th, 2010 to June 6th, 2013 admitted to the Department of Orthopaedic Surgery,
L. Eide1 , A.H. Ranhoff1 , B. Fridlund2 , R. Haaverstad3 , K.O. Hufthammer3 , K.J. Kuiper3 , J.E. Nordrehaug4 , T.M. Norekval ˚ 3 1 2 University of Bergen, Bergen, Norway; J¨ onk¨ oping University, J¨ onk¨ oping, Sweden; 3 Haukeland University Hospital, Bergen, Norway; 4 Department of Clinical Science, University of Bergen, Bergen, Norway Objectives: To establish whether postoperative delirium (PD) predicts cognitive function in octogenarian patients 6 months after treatment with transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR). Methods: This is a prospective cohort study of octogenarian patients (N = 143) in a tertiary university hospital. Inclusion criteria: ≥80 years, severe aortic stenosis, elective TAVI/SAVR. Exclusion
no difference in pre-operative CSF S100B levels between delirious and non-delirious patients (median: 1053 pg/mL, inter-quartile range (IQR): 601–1178 versus median: 862 pg/mL, IQR: 701– 1156, p = 0.760). The two patients with pre-operative delirium seemed to have higher S100B levels (1052 pg/mL and 2258 pg/mL) than patients with post-operative or no delirium (median: 848 pg/mL, IQR: 595–1177 and median 862 pg/mL, IQR: 701–1156, respectively). Conclusion: Pre-operative CSF S100B levels did not differ between patients with and without delirium. The higher S100B levels in two patients with delirium at the time of CSF sampling suggest that timing is important in determining the association between delirium and S100B. P-169 Relation between S100B and delirium remains controversial S. Beishuizen Academical Medical Centre, Amsterdam, Netherlands Objectives: Delirium is associated with subsequent increased risk of dementia. This may reflect actual brain damage that arises during a delirious episode. Several studies suggest that S100B, a marker of brain damage, is elevated during delirium. We aim to assess the association between serum S100B levels and delirium in order to further elucidate the pathophysiology of delirium. Methods: This was a prospective cohort study including patients aged 65 years and older who were admitted for surgical repair of a hip fracture. Delirium was diagnosed using the Confusion Assessment Method (CAM). A maximum of four serum samples were obtained per patient during admission. S100B was measured using enzyme-linked immunosorbent assay. Results: 995 samples of 385 patients, aged 65–102 years old, were analyzed. 226 patients (59%) had prior cognitive impairment. Cognitive impaired patients were older (86.3 vs. 80.6 years old, p < 0.001), had more functional impairments (Katz-ADL-score 9 vs. 2, p < 0.001) and more often experienced delirium (44.7% vs. 16.4%, p < 0.001). Comparing the first samples during delirium to samples of non-delirious patients, no difference in S100B level was observed (median 0.09 mcg/L versus 0.08 mcg/L, p = 0.219). Multilevel analysis, adjusted for age, prior cognitive impairment, surgery and infection showed no association between S100B level and delirium (p = 0.32). However, surgery (Beta 0.029, p < 0.001), infection (Beta 0.013, p = 0.04) and older age (Beta 0.001, p = 0.01) were associated with increased S100B levels. Conclusion: In our cohort of older hip fracture patients, we found no association between S100B levels and delirium. The relation between S100B and delirium therefore remains controversial.
S77
Aarhus University Hospital. There were 179 patients included in the study. The first day of hospitalization all enrolled patients were examined for cognitive impairment (assessed by the Mini Mental State Examination) and delirium (assessed by Confusion Assessment Method). Delirium was also assessed on the 10th postoperative day. Results: The prevalence of delirium was 11% in patients allocated to a liberal blood transfusion threshold (LB) and 22% in the group with a restrictive transfusion threshold (RB). There was association between LB and RB and development of delirium day 10th, OR 0.41 (95% CI: 0.17–0.96), p = 0.04. Delirium on day 10th increased the probability of 90-day mortality OR 2.91 (95% CI: 1.28–6.64), p = 0.01. Conclusion: In nursing home residents, a maintained hemoglobin level above 11.3 g/dL does reduce the probability of developing postoperative delirium day 10th compared with a restrictive transfusion strategy. Development of postoperative delirium increases the probability of mortality. P-171 Delirium within the first week of stroke – a pilot study M. Buckley1 , M. Ramjee2 , R. Coary2 , A. Fallon3 , S.P. Kennelly3 Age Related Healthcare, Adelaide and Meath hospital, Dublin, Ireland; 2 ARHC, Adelaide and Meath Hospital, Tallaght, Ireland; 3 Tallaght Hospital, Dublin, Ireland
1
P-170 Blood transfusion strategy and risk of postoperative delirium in nursing homes residents with hip fracture
Objectives: Delirium is common in acute stroke. Studies indicate prevalence ranges from 13–48%. The purpose of this study is to assess the prevalence of delirium in the first week of stroke and to determine risk factors for the development of delirium. Methods: Patients admitted to our Acute Stroke Unit were included. Underlying cognitive impairment was assessed using AD8 questionnaire. Delirium screen comprising of 6CIT and DRS was undertaken daily for the first 7 days of admission and data was collected to assess for potential causes of a delirium. Results: 34 people have been recruited to date with an average age of 67.9 years. 17.6% of patients (n= 6) had a previous diagnosis of dementia. 20.6% (n = 7) were diagnosed with delirium during the first week of stroke. Average age of these patients was 65 (range 40–79). 2 of these patients had a history of dementia. 28.6% (n = 2) had large haemorrhagic TACS and were under the age of 50. 42.8% (n = 3) had an ischaemic PACS and 28.6% had ischaemic POCS. 2 were on intravenous antibiotic therapy and 2 had documented constipation. The median time for patients to be transferred to the Acute Stroke Unit was 23 hours. In the group who developed delirium, median time to transfer was 48 hrs. Conclusions: Data collection is currently ongoing. Our results to date suggest that delirium occurs in 20% of our patients. Partial anterior circulation stroke syndromes were most likely to become delirious, although this group had 2 patients with dementia.
S. Blandfort1 , E.M. Damsgaard2 , M. Gregersen2 Departments of Geriatrics, Aarhus University Hospital, Aarhus C., Denmark; 2 Department of Geriatrics, Aarhus University Hospital, Aarhus C, Denmark
P-172 Can the development of delirium predict cognitive function after aortic valve implantation?
1
Objectives: To investigate whether a liberal blood transfusion strategy (Hb levels ≥11.3 g/dL (7 mmol/L)) reduces the risk of postoperative delirium day 10th in nursing homes residents with hip fracture, compared with a restrictive transfusion strategy (Hb levels ≥9.7 g/dL (6 mmol/L)). Furthermore, to investigate whether postoperative delirium increases mortality within 90 days after hip surgery. Methods: A post-hoc analysis based on The TRIFE randomized controlled trail. Consecutive recruitment of frail anemic patients (aged ≥65 years), residing in nursing homes suffering from unilateral hip fracture, in the period from January 18 th, 2010 to June 6th, 2013 admitted to the Department of Orthopaedic Surgery,
L. Eide1 , A.H. Ranhoff1 , B. Fridlund2 , R. Haaverstad3 , K.O. Hufthammer3 , K.J. Kuiper3 , J.E. Nordrehaug4 , T.M. Norekval ˚ 3 1 2 University of Bergen, Bergen, Norway; J¨ onk¨ oping University, J¨ onk¨ oping, Sweden; 3 Haukeland University Hospital, Bergen, Norway; 4 Department of Clinical Science, University of Bergen, Bergen, Norway Objectives: To establish whether postoperative delirium (PD) predicts cognitive function in octogenarian patients 6 months after treatment with transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR). Methods: This is a prospective cohort study of octogenarian patients (N = 143) in a tertiary university hospital. Inclusion criteria: ≥80 years, severe aortic stenosis, elective TAVI/SAVR. Exclusion