The relationship between serum cobalamin, folic acid, and homocysteine and the risk of post-cardiac surgery delirium

Figures & data

Table 1 Baseline characteristics of patients based on delirium and non-delirium of subjects

Variable	Total (n=296)	Delirium (n=68)	Non-delirium (n=228)	P-value
Age (years)	62 (54–66)	64 (59–73)	61 (53–66)	<0.001**
Gender, n (%)				0.92***
Female	64 (22)	16 (23)	48 (21)
Male	232 (78)	52 (77)	180 (79)
Education level, n (%)				0.007***
Illiterate	104 (35)	38 (56)	66 (29)
Less than diploma	136 (46)	24 (35)	112 (49)
Diploma	40 (14)	0 (0)	40 (18)
College education	16 (5)	6 (9)	10 (4)
NYHA classification, n (%)				0.23***
Class II	236 (80)	50 (73)	186 (82)
Class III	38 (13)	8 (12)	30 (13)
Class IV	22 (7)	10 (15)	12 (5)
Type of surgery, n (%)				0.50***
SVD	20 (7)	6 (9)	14 (6)
2VD	56 (19)	10 (15)	46 (20)
3VD	208 (70)	50 (73)	158 (69)
CABG+ valvular	12 (4)	2 (3)	10 (5)
Hemoglobin,^a (g/dL)	13.70±1.83	13.39±1.66	13.80±1.88	0.25*
Comorbidities
Diabetes mellitus, n (%)	132 (45)	30 (44)	102 (45)	0.65***
Hypertension, n (%)	150 (51)	42 (62)	108 (47)	0.04***
Hyperlipidemia n (%)	104 (35)	18 (26)	86 (38)	0.02***
Smoker, n (%)	82 (28)	14 (21)	68 (30)	0.34***
Addiction, n (%)	54 (18)	14 (21)	40 (17)	0.90***
Eye problem, n (%)	20 (7)	10 (15)	10 (4)	0.001***
Ear/language barrier, n (%)	26 (9)	8 (12)	18 (8)	0.29***
Alcohol use	0	0	0	1
CPB duration (h:min)	4:3 (4–4:47)	4:3 (3:82–5:07)	4:2 (4:0–4:45)	0.33**
Post-surgery sodium, mg/dL	140.76±12.04	142.91±2.9	140.12±13.56	0.005*
Post-surgery potassium,  mg/dL	4.5 (4.2–4.7)	4.5 (4.3–4.7)	4.5 (4.2–4.7)	0.48**
Post-surgery creatinine,  mg/dL	1.20±0.32	1.34±0.42	1.16±0.27	0.005*
Poor mobilization, n (%)	72 (24)	12 (18)	60 (26)	0.60***
Poor sleep, n (%)	48 (16)	8 (12)	40 (17)	0.54***
LOS ICU, days	2 (2–4)	4 (2–5)	2 (2–3)	0.00**
LOS hospital, days	6 (5–7)	7 (6–9)	6 (5–7)	0.00**
Acute infection, n (%)	6 (2)	2 (3)	4 (2)	0.45***

Notes: *Student's t-test (mean ± SD) **Mann–Whitney U-test (median, IQR) ***Chi-square test. ^aPre-surgery.

Abbreviations: NYHA, New York Heart Association Heart Function; SVD, single vessel disease; CABG, coronary artery bypass grafting; CPB, cardiopulmonary bypass; 2VD, two vessel disease; 3VD, three vessel disease; LOS, length of stay; ICU, intensive care unit.

Figure 1 Study flowchart.

Abbreviation: CABG, coronary artery bypass grafting.

Table 2 Logistic regression analysis for delirium

	OR	95% CI	P-value	Adjusted OR*	95% CI	P-value
Delirium
Age	1.06	1.03–1.10	0.001	1.03	1.00–1.06	0.03
Sodium^a	1.11	1.02–1.21	0.008
Creatinine^a	5.6	2.56–12.27	0.001	2.66	1.07–6.60	0.03
Hyperlipidemia	1.94	1.08–3.48	0.02
Hypertension	0.58	0.34–0.99	0.04
Vision impairment	0.25	0.10–0.60	0.001
Cobalamin subgroups:
Borderline (n=104)	1.36	0.74–2.52	0.31	1.40	0.71–2.70	0.32
Deficiency (n=86)	0.54	0.25–1.15	0.11	0.69	0.30–1.55	0.37
Normal (n=106)	Reference
Folic acid subgroups:
Deficiency (n=18)	0.84	0.27–2.60	0.76	0.97	0.27–3.50	0.98
Normal (n=278)	Reference
Homocysteine subgroups:
Mild (n=186)	1.57	0.66–3.70	0.30	1.02	0.45–2.43	0.82
Intermediate (n=14)	0	0	0.99	0	0	0.99
Normal (n=96)	Reference

Notes: *Adjusted by age, impaired vision, hypertension, hyperlipidemia, postoperative serum sodium and creatinine. ^aPost-surgery.