
Figure 1: Screening/allocation procedure. N=number of patients in each group
Total (n=69) | Delirium (n=20) | No Delirium (n=49) | p value | ||||
Gender | Male | 50 (72.5%) | Male | 17 (34.0%) | Male | 33 (66.0%) | 0.234 # |
Female | 19 (27.5%) | Female | 3 (15.8%) | Female | 16 (84.2%) | ||
Age (years) | 66.65 (± 10.46) | 65.60 (± 8.53) | 65.67 (± 11.24) | 0.979 § | |||
ASA class | ASA 3 | 7 (10.1%) | ASA 3 | 1 (4.5%) | ASA 3 | 7 (10.1%) | 0.664 # |
ASA 4 | 62 (89.9%) | ASA 4 | 19 (95.5) | ASA 4 | 62 (89.9%) | ||
ADS (antichilinergic drud scale) | 0 | 59 (85.5%) | 0 | 17 (85.0%) | 0 | 42 (85.7%) | all > 0.05 |
1 | 8 (11.6%) | 1 | 3 (15.0%) | 1 | 5 (10.2%) | ||
2 | 1 (1.4%) | 2 | 0 | 2 | 1 (2.0%) | ||
3 | 0 | 3 | 0 | 3 | 0 | ||
4 | 1 (1.4%) | 4 | 0 | 4 | 1 (2%) | ||
Euroscore | 1.61 (± 1.38) | 1.99 (± 1.57) | 1.45 (± 1.28) | 0.123 | |||
Smoker | Yes | 31 (44.9%) | Yes | 11 (35.5%) | Yes | 20 (64.5%) | 0.301 # |
NO | 38 (55.1%) | NO | 9 (64.5%) | NO | 28 (35.5%) | ||
C2 intake (Regular) | Yes | 33 (47.8%) | Yes | 14 (70.0%) | Yes | 19 (38.8%) | 0.032*# |
NO | 36 (52.2 %) | NO | 6 (30.0%) | NO | 30 (61.2%) |
Table 1: Baseline characteristics (n = number of patients; p=level of significance [<0.05]; ASA = physical status classification system; ADS = anticholinergic drug scale [0= no anticholinergic drugs; 4= very high “load”]; C2 = ethanol [drinking]; § = independent sample t-test; # = exact fisher test; ^ = Mann-Whitney-U test; * = significant difference)
AChE mean (SD) | Delirium, n = 20 | No delirium, n = 49 | Effect size | p-value |
Baseline | 46 (6) | 48 (9) | 0.28(cohen´s r) | 0.6W |
Before anesthesia (induction) | 47 (8) | 46 (7) | 0.23(cohen´s d) | 0.4T |
Admission intensive care unit | 43 (6) | 45 (8) | 0.18(cohen´s d) | 0.5T |
1st postoperative day | 44 (5) | 45 (8) | 0.13(cohen´s d) | 0.6T |
2nd postoperative day | 45 (5) | 45 (5) | 0.07(cohen´s d) | 0.8T |
3rd postoperative day | 46 (5) | 46 (6) | 0.01(cohen´s d) | >0.9T |
Table 2: comparison of AChE values (acetylcholinesterase in U/g Hb [units per gram hemoglobin]). SD = standard deviation; w Mann-Whitney-U test (with median values without normal distribution); T independent sample t-test (with mean values with normal distribution); p-values (level of significance [<0.05]); f = effect size. Values of AChE baseline were not distributed equally.
BChE mean (SD) | Delirium,n = 20 | No delirium,n = 49 | Effect size | p-value |
Baseline | 3,419 (668) | 3,393 (799) | 0.03(cohen´s d) | >0.9T |
Before anesthesia (induction) | 3,338 (854) | 3,355 (766) | 0.02(cohen´s d) | >0.9 T |
Admission intensive care unit | 3,277 (918) | 3,097 (608) | 0.3(cohen´s d) | 0.3T |
1st postoperative day | 3,105 (834) | 2,906 (528) | 0.15(cohen´s r) | 0.2W |
2nd postoperative day | 2,639 (467) | 2,561 (477) | 0.16(cohen´s d) | 0.5T |
3rd postoperative day | 2,529 (516) | 2,614 (540) | 0.16(cohen´s d) | 0.5T |
Table 3: Comparison of BChE values (butyrylcholinesterase in U/l [units per liter]). SD = standard deviation; w Mann-Whitney-U test (with median values without normal distribution); T Two Sample t-test (with mean values with normal distribution); w Mann-Whitney-U test; T independent sample t-test; p-values (level of significance [<0.05]). Variances BChE 1st postop. day unequal.
AChE (p/r(r*)/n) | Leukocytes Delirium | Leukocytes Non-Delirium | CRP Delirium | CRP Non-Delirium | Il-6 Delirium | Il-6 Non-Delirium |
Baseline | p=0.855 r=0.05 (n=16) | p=0.684 -0.07 (n=38) | p=0.816 r=0.06 (n=16) | p=0.149 r*=0.24 (n=39)* | na (n=0) | na (n=1) |
Induction | p=0.47 r=0.2 (n=15) | p=0.223 r=0.18 (n=46) | na (n=1) | p=0.582 r=0.19 (n=11) | na (n=0) | na (n=1) |
Admission | p=0.749 r=0.14 (n=8) | p=0.084 r=0.43 (n=17) | na (n=1) | p=0.796 r=-0.2 (n=4) | na (n=2) | p=0.002 r=1 (n=4) |
postOP1 | p=0.125 r=0.35 (n=20) | p=0.284 r=0.16 (n=48) | p=0.554 r=0.14 (n=20) | p=0.088 r=-0.25 (n=47) | p=0.847 r=0.05 (n=18) | p=0.189 r=0.02 (n=38) |
postOP2 | p=0.44 r=0.18 (n=20) | p=0.942 r=0.01 (n=48) | p=0.081 r=0.4 (n=20) | p=0.612 r=-0.08 (n=45) | p=0.821 r=-0.07 (n=14) | p=0.368 r=-0.16 (n=32) |
postOP3 | p=0.518 r=-0.16 (n=19) | p=0.656 r=-0.07 (n=47) | p=0.689 r=-0.1 (n=19) | p=0.499 r=-0.1 (n=44) | p=0.489 r=0.25 (n=10) | p=0.766 r=0.06 (n=27) |
Table 4: Correlations between acetylcholinesterase (AChE), occurrence of delirium and common inflammation parameters (Leukocytes; CRP [c”c-reactive protein”] and Il-6 [“interleukin six”]. All correlations with normal distribution of parameters were done with Pearson-correlation; except those without normal distribution:* =Spearman correlation. The number in the tabe are the correlation coefficients. Induction was start of anesthesia; admission was arrival on intensive care unit; postop 1-3 were postoperative days 1-3; r = cohen´s r (effect size for pearson correlation); r*=spearman correlation (without normal distribution)
BChE (p/r(r*)/n) | Leukocytes Delirium | Leukocytes Non-Delirium | CRP Delirium | CRP Non-Delirium | Il-6 Delirium | Il-6 Non-Delirium |
Baseline | p=0.894 r=-0.04 (n=16) | p=0.69 r=0.07 (n=38) | p=0.761 r=0.08 (n=16) | p=0.206 r*=-0.21 (n=39)* | na (n=0) | na (n=1) |
Induction | p=0.134 r=-0.41 (n=15) | p=0.448 r=-0.11 (n=46) | na (n=1) | p=0.01 r=-071 (n=11) $ | na (n=0) | na (n=1) |
Admission | p=0.095 r=-0.63 (n=8) | p=0.194 r=-0.33 (n=17) | na (n=1) | p=0.626 r=0.37 (n=4) | na (n=2) | p=0.089 r=-0.91 (n=4) |
postOP1 | p=0.808 r=-0.06 (n=20) | p<0.001 r=-0.5 (n=48) $ | p=0.632 r=0.11 (n=20) | p=0.723 r=-0.05 (n=47) | p=0.096 r=0.4 (n=18) | p=0.862 r=0.03 (n=38) |
postOP2 | p=0.992 r=0 (n=20) | p=0.024 r=-0.33 (n=48) $ | p=0.943 r=-0.02 (n=20) | p=0.574 r=0.09 (n=45) | p=0.608 r=-0.15 (n=14) | p=0.871 r=-0.03 (n=32) |
postOP3 | p=0.848 r=0.05 (n=19) | p=0.005 r=-0.41 (n=47) $ | p=0.689 r=-0.1 (n=19) | p=0.904 r=0.02 (n=44) | p=0.437 r=0.28 (n=10) | p=0.761 r=-0.06 (n=27) |
Table 5: Correlations between butyrylcholinesterase (BChE), occurrence of delirium and common inflammation parameters (Leukocytes; CRP [c”c-reactive protein”] and Il-6 [“interleukin six”]. All correlations with normal distribution of parameters were done with Pearson-correlation; except those without normal distribution:* =Spearman correlation. The number in the tabe are the correlation coefficients. $ = indicates significant correlation. Induction was start of anesthesia; admission was arrival on intensive care unit; postop 1-3 were postoperative days 1-3; r = cohen´s r (effect size for pearson correlation); r*=spearman correlation (without normal distribution)
Figure 1: Screening/allocation procedure. N=number of patients in each group
Figure 2: Overview of the perioperative measures carried out (Nu-DESC = Nursing Delirium Screening Scale; CAM-ICU = confusion assessment method for the intensive care unit; AChE = acetylcholinesterase; BChE = butyrylcholinesterase; CRP = c-reactive protein; Il-6 = interleukin 6; 1-6: perioperative time points
Figure 3: Boxplots of perioperative course of AChE (acetylcholinesterase in U/g Hb [units per gram hemoglobin]) in delirious (left diagram) and non-delirious (right diagram) patients. postop 1-3 = postoperative days 1-3; ICU = intensive care unit; induction = anesthesia induction). Displayed are mean differences (mean values; upper & lower quantile & extremes [dots]). Average differences between patients with and without delirium: hospital admission: -2/ before anesthesia: 1/ admission Intensive Care Unit: -2/ 1st postoperative day: -1/ 2nd postoperative day: 0.5/ 3rd postoperative day: 0
Figure 4: Boxplots of perioperative course of BChE (butyrylcholinesterase in U/l [units per litre]) in delirious (left diagram) and non-delirious (right diagram) patients. postop 1-3 = postoperative days 1-3; ICU = intensive care unit; induction = anesthesia induction). Displayed are mean differences (mean values; upper & lower quantil & extremes [dots]). Average differences between patients with and without delirium: hospital admission: 26/ before anesthesia: 17/ admission Intensive Care Unit: 180/ 1st postoperative day: 199/ 2nd postoperative day: 78/ 3rd postoperative day: 85
Tables at a glance
Figures at a glance