Liver transplant patients with high levels of preoperative serum bilirubin are at increased risk for postoperative delirium: a retrospective study

초록

Background: Postoperative delirium is a common complication in patients undergoing liver transplantation (LT). High model for end-stage liver disease (MELD) score is one of the independent risk factor of postoperative delirium, however, it is controversial which of the components of the MELD score are indicators of risk. The aim of this study is to compare the incidence of delirium depending on the preoperative serum bilirubin concentration level, a component of the MELD score, in patients after liver transplantation (LT). Methods: Medical records from 325 patients who received LT from January 2010 to February 2019 in a single university hospital were retrospectively reviewed. Patients were divided with 2 groups: Those who were with delirium after LT (D group, n = 69) and those who were without delirium after LT (C group, n = 256) after LT in intensive care unit (ICU). The patients' demographic data, perioperative managements and postoperative complications were collected. Results: The preoperative bilirubin level was 16.60 (3.90, 29.00) μmol/l in group D and the preoperative bilirubin level was 2.40 (1.30, 12.62) μmol/l in group C (P < 0.0001). In Group D, 54 (78.26) patients had preoperative bilirubin levels above 3.5 μmol/l and 15 (21.74) patients under 3.5 μmol/l. In multivariate analysis, preoperative bilirubin above 3.5 μmol/l is associated with postoperative incidence of delirium (P = 0.002). Conclusions: Preoperative elevated serum bilirubin above 3.5 μmol/l is an independent risk factor in postoperative incidence of delirium.