Neuropsychiatric Disease and Treatment (Jul 2020)

Analysis of Risk Factors for Postoperative Delirium After Liver Transplantation

  • Chen J,
  • Wang H,
  • He Z,
  • Li T

Journal volume & issue
Vol. Volume 16
pp. 1645 – 1652

Abstract

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Junguo Chen, Hao Wang, Zhijun He, Ting Li Department of Organ Transplantation, The Second Xiangya Hospital, Central South University, Changsha, People’s Republic of ChinaCorrespondence: Ting LiLiver Transplantation, The Second Xiangya Hospital, No. 139 Middle Renmin Road, Changsha 410011, People’s Republic of ChinaTel +86 15084909000Email [email protected]: The study aimed to analyze the incidence of postoperative delirium (POD) and associated risk factors after liver transplantation (LT).Patients and Methods: We identified and enrolled patients undergoing LT at the Second Xiangya Hospital, Central South University between August 2018 and May 2019. We abstracted their relevant clinical information and assigned the patients into a POD group and non-POD group to compare differences in clinical information. Risk factors of POD were analyzed using logistic regression.Results: A total of 159 LT patients were enrolled. Forty-two patients exhibited delirium (26.4%). Of the 42 with delirium, 33 (78.6%) had delirium within 3 days postoperatively and a median duration of 5 days (quartile 3– 7 days). The results of binary logistic regression are as follows: preoperative ammonia (≥ 46 vs < 46 μmol/L; OR 3.51, 95% CI [1.31– 9.46], P< 0.05), Model for End-Stage Liver Disease (MELD) score (≥ 15 vs.< 15; OR 3.33, 95% CI [1.27– 8.79], P< 0.05), presence of hepatic encephalopathy (OR 3.30, 95% CI [1.20– 9.07], P< 0.05), aspartate aminotransferase (AST) on day 1 postoperatively (OR 1.33, 95% CI [1.06 − 1.68], P< 0.05), anhepatic period (OR 1.04, 95% CI [1.02 − 1.06], P< 0.01). The POD group had a longer intubation time (2925.0 vs 1410.0 min, P< 0.01), ICU length of stay (6 vs 4 d, P< 0.01) and increased medical costs (43.96 vs 33.74 ten thousand yuan, P< 0.01).Conclusion: The incidence of POD in LT patients is a significant clinical feature. Ammonia ≥ 46 μmol/l, MELD score ≥ 15, hepatic encephalopathy, anhepatic period, and AST at 1 day postoperatively were independent risk factors for POD.Keywords: liver transplantation, postoperative delirium, ammonia, hepatic encephalopathy, risk factors

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