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Poster presentations / European Geriatric Medicine 6S1 (2015) S32
–
S156
S77
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 0.09mcg/L versus 0.08mcg/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.
P-170
Blood transfusion strategy and risk of postoperative delirium
in nursing homes residents with hip fracture
S. Blandfort
1
, E.M. Damsgaard
2
, M. Gregersen
2
1
Departments of Geriatrics, Aarhus University Hospital, Aarhus C.,
Denmark;
2
Department of Geriatrics, Aarhus University Hospital,
Aarhus C, Denmark
Objectives:
To investigate whether a liberal blood transfusion
strategy (Hb levels ≥11.3 g/dL (7mmol/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 (6mmol/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,
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. Buckley
1
, M. Ramjee
2
, R. Coary
2
, A. Fallon
3
, S.P. Kennelly
3
1
Age Related Healthcare, Adelaide and Meath hospital, Dublin, Ireland;
2
ARHC, Adelaide and Meath Hospital, Tallaght, Ireland;
3
Tallaght
Hospital, Dublin, Ireland
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.
P-172
Can the development of delirium predict cognitive function
after aortic valve implantation?
L. Eide
1
, A.H. Ranhoff
1
, B. Fridlund
2
, R. Haaverstad
3
,
K.O. Hufthammer
3
, K.J. Kuiper
3
, J.E. Nordrehaug
4
, T.M. Norekv ˚al
3
1
University of Bergen, Bergen, Norway;
2
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