Petras Navickas1, Laura Lukavičiūtė1, Alvydas Navickas1,2, Pranas Šerpytis1,3,4, Rokas Šerpytis1,3
1Vilnius University Medical Faculty, Vilnius, Lithuania
2Vilnius University Medical Faculty Psychiatric Clinic, Vilnius, Lithuania
3Vilnius University Hospital Santariškių Klinikos, Centre of Cardiology and Angiology, Vilnius, Lithuania
4Vilnius University Hospital Santariškių Klinikos, Centre of Emergency Medicine, Vilnius, Lithuania
Background and objective: GRACE risk score (GRS) is a scoring system which has a prognostic significance in patients with myocardial infarction. Since more than every second patient with delirium in the cardiac intensive care unit (ICCU) setting are admitted due to myocardial infarction, we aimed to determine whether GRS is associated with delirium onset time, length of stay (LOS) and mortality.
Methods: Patients with ACS who were admitted to the ICCU of Vilnius University Hospital Santariškių Clinics were retrospectively evaluated. From a sample of 11,599 ICCU admissions, 157 (1.4%) had documented delirium diagnosed through liaison and consultation with a psychiatrist and were included in the final analysis. The GRS was calculated on admission using specified variables and a Spearman correlation analysis was used for the relation between GRS and delirium onset time, LOS and mortality.
Results: From a total of 157 patients 85 were males and 72 – females. The average GRS was 191 ± 3.915, 95% Confidence Interval (CI) 183.25 – 198.72 (equating to an average of 14% intra-hospital death probability). The score did not statistically differ between genders. Additionally, the GRS amongst those with lethal outcomes was statistically higher compared to those with positive outcomes (243.13 ± 10.334 vs. 188.19 ± 3.964, p = <0.001). However, the actual intra-hospital mortality was considerably lower than presumed by the GRS and accounted for 5.1%. Although there was a significant positive correlation between the LOS in the ICCU and GRS (Rho 0.18573, p = 0.01987), there was no correlation with the overall hospitalization length (Rho -0.05538, p = 0.491) and delirium onset time (Rho 0.18573, p = 0.01987).
Conclusions: Higher GRACE risk score was associated with intra-hospital mortality but was not very effective predicting it. Also the study showed that GRACE risk score poorly predicts length of stay and it does not predict delirium onset time. Further investigation is needed to determine whether GRS could be used to predict the development of delirium.