title: Impact of malnutrition on postoperative delirium development after on pump coronary artery bypass grafting.
abstract: OBJECTIVE
  Even though malnutrition is frequently observed in cardiac population outcome data after cardiac surgery in malnourished patients is very rare. No thorough research was done concerning the impact of malnutrition on neuropsychological outcomes after cardiac surgery. The aim of our study was to analyze the incidence of postoperative delirium development in malnourished patients undergoing on pump bypass grafting.
  
  
  METHODS
  We performed a cohort study of adults admitted to Vilnius University Hospital Santariskiu Clinics for elective coronary artery bypass grafting. The nutritional status of the patients was assessed by Nutritional Risk Screening 2002 (NRS-2002) questionnaire the day before surgery. Patients were considered as having no risk of malnutrition when NRS-2002 score was less than 3 and at risk of malnutrition when NRS-2002 score was ≥3. During ICU stay patients were screened for postoperative delirium development using the CAM-ICU method. and divided into two groups: delirium and non delirium. The statistical analysis was preformed to evaluate the differences between the two independent groups. The logistic regression model was used to evaluate the potential preoperative and intraoperative risk factors of postoperative delirium.
  
  
  RESULTS
  Ninety-nine patients were enrolled in the study. Preoperative risk of malnutrition was detected in 24 % (n = 24) of the patients. The incidence of early postoperative delirium in overall study population was 8.0 % (n = 8). The incidence of the patients at risk of malnutrition was significantly higher in the delirium group (5 (62.5 %) vs 19 (20.9 %), p <0.0191). In multivariate logistic regression analysis risk of malnutrition defined by NRS 2002 was an independent preoperative and intraoperative risk factor of postoperative delirium after coronary artery bypass grafting (OR: 6.316, 95 % CI: 1.384-28.819 p = 0.0173).
  
  
  CONCLUSIONS
  Preoperative malnutrition is common in patients undergoing elective coronary artery bypass grafting. Nutrition deprivation is associated with early postoperative delirium after on pump coronary artery bypass grafting.
authors.affiliation: Clinic of Anesthesiology and Intensive care, Vilnius University, Faculty of medicine, Vilnius, Lithuania. donata.ringaitiene@santa.lt.|Center of Anesthesia and Intensive care Vilnius University Hospital Santariskiu Klinikos, Santariskiu 2, Vilnius, Lt 08448, Lithuania. donata.ringaitiene@santa.lt.
authors.forename: Donata
authors.initials: D
authors.lastname: Ringaitienė
authors.affiliation: Vilnius University, Faculty of Medicine, Vilnius, Lithuania. d.gineityte@santa.lt.
authors.forename: Dalia
authors.initials: D
authors.lastname: Gineitytė
authors.affiliation: Vilnius University, Faculty of Medicine, Vilnius, Lithuania. vaidas.vicka@santa.lt.
authors.forename: Vaidas
authors.initials: V
authors.lastname: Vicka
authors.affiliation: Hematology, Oncology and Transfusion Medicine Center, Vilnius University Hospital Santariskiu Klinikos, Vilnius, Lithuania. tadas.zvirblis@santa.lt.
authors.forename: Tadas
authors.initials: T
authors.lastname: Žvirblis
authors.affiliation: Clinic of Anesthesiology and Intensive care, Vilnius University, Faculty of medicine, Vilnius, Lithuania. jurate.sipylaite@santa.lt.|Center of Anesthesia and Intensive care Vilnius University Hospital Santariskiu Klinikos, Santariskiu 2, Vilnius, Lt 08448, Lithuania. jurate.sipylaite@santa.lt.
authors.forename: Jūratė
authors.initials: J
authors.lastname: Šipylaitė
authors.affiliation: Hepatology and Gastroenterology Department, Vilnius University faculty of Medicine. Centre of Hepatology, Gastroenterology and Dietetics, Vilnius University Hospital Santariskiu Klinikos, Vilnius, Lithuania. algimantas.irnius@santa.lt.
authors.forename: Algimantas
authors.initials: A
authors.lastname: Irnius
authors.affiliation: Clinic of Anesthesiology and Intensive care, Vilnius University, Faculty of medicine, Vilnius, Lithuania. juozas.ivaskevicius@rvul.lt.
authors.forename: Juozas
authors.initials: J
authors.lastname: Ivaškevičius
authors.affiliation: Department of Physiology, Biochemistry, Microbiology and Laboratory Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania. tomas.kacergius@mf.vu.lt.
authors.forename: Tomas
authors.initials: T
authors.lastname: Kačergius
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D003324:Coronary Artery Disease / Q000601:surgery; D003693:Delirium / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008097:Lithuania / Q000453:epidemiology; D008297:Male; D044342:Malnutrition / Q000150:complications* / Q000453:epidemiology; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors