Association between vitamin D concentration and delirium in hospitalized patients: A meta-analysis

Vitamin deficiency, a neglected risk factor for post-anesthesia complications: a systematic review

BACKGROUND

Some evidence highlights individuals lacking an adequate level of vitamins may experience heightened susceptibility to post-anesthesia complications. The current study summarized the previous evidence assessing the impact of deficient vitamin levels on complications and outcomes following anesthesia.

METHODS

A comprehensive search in scientific English databases was conducted from January 2000 to January 2024. The inclusion and exclusion criteria were applied, the full-texts were thoroughly analyzed, and the risk-of-bias was assessed.

RESULTS

A multitude of 1322 published articles were discovered based on search strategy and 14 eligible papers were enrolled. The mean age of patients was 39.3 years and the majority were male. Patients with vitamin B12 deficiency experienced both neurological and hematologic consequences post-anesthesia. Delirium was observed among patients lacking sufficient levels of vitamin D, and those deficient in vitamin K presented symptoms indicative of epidural hematoma. Post-anesthesia consequences were manifested with a delay, ranging from hours to days following the anesthesia procedure in vitamin K and B12 deficiency, while patients deficient in vitamin C and B1 experienced an acute onset of symptoms during surgery. Significantly, a notable proportion (42%) had pre-existing risk factors for vitamin deficiency prior to the surgery, while 35% of the risk-factors for vitamin deficiency were diagnosed after the surgery. There was a wide range of complete or partial recovery periods following surgical intervention, spanning over a few days up to several months according to the severity of symptoms.

CONCLUSIONS

Based on the evidence from the reviewed studies, this study robustly suggests that serum vitamins level before surgery should be measured among patients who are at risk of vitamin deficiency or have some related clinical symptoms.

Secondary osteoporosis prevention: three-year outcomes from a Fracture Liaison Service in elderly hip fracture patients

BACKGROUND

Hip fractures are the most serious fragility fractures due to their associated disability, higher hospitalization costs and high mortality rates. Fracture Liaison Service (FLS) programs have enhanced the management of osteoporosis-related fractures and have shown their clinical effectiveness.

AIMS

To analyze the effect of the implementation of a FLS model of care over the survival and mortality rates following a hip fracture.

METHODS

We conducted a prospective cohort study on patients over 60 years of age who suffered a hip fracture before and after the implementation of the FLS in our center (between January 2016 and December 2019). Patients were followed for three years after the index date. Mortality, complications and refracture rates were compared between the two groups using a Multivariate Cox proportional hazard model.

RESULTS

A total of 1366 patients were included in this study (353 before FLS implementation and 1013 after FLS implementation). Anti-osteoporotic drugs were more frequently prescribed after FLS implementation (79.3% vs 12.5%; p < 0.01) and there was an increase in adherence to treatment (51.7% vs 30.2%; p < 0.01). A total of 413 (40.8%) patients after FLS implementation and 141 (39.9%) individuals before (p = 0.47) died during the three-years follow-up period. A second fracture occurred in 101 (10.0%) patients after FLS implementation and 37 (10.5%) individuals before (p = 0.78). Patients after the implementation of the FLS protocol had a lower all cause one-year mortality [adjusted Hazard Ratio (HR) 0.74 (0.57-0.94)] and a decreased risk of suffering a second osteoporotic fracture [adjusted HR 0.54 (0.39-0.75) in males and adjusted HR 0.46 (0.30-0.71) in females].

CONCLUSIONS

The implementation of a FLS protocol was associated with a lower all-cause one-year mortality rate and a higher survivorship in elderly hip fracture patients. However, no three-year mortality rate differences were observed between the two groups. We also found a reduction in the complication and second-fracture rates.

Causal relationships between delirium and Parkinson's disease: a bidirectional two-sample Mendelian randomization study

BACKGROUND

Previous observational studies have suggested a notably elevated prevalence of delirium in individuals diagnosed with Parkinson's disease (PD), thereby implying a potential increased susceptibility to delirium among PD patients. However, it is imperative to acknowledge that observational studies inherently possess limitations, rendering it arduous to establish a definitive causal or reverse causal association between delirium and PD.

METHODS

To explore the relationship between delirium and PD, a bidirectional two-sample Mendelian randomization (MR) was conducted using summary statistics obtained from genome-wide association studies. The main analysis was performed using the inverse-variance weighted (IVW) method, with further analyses conducted using MR Egger, weighted median, and weighted mode to ensure accuracy of findings. Additionally, Cochran's Q statistics and MR Egger intercept were utilized to assess heterogeneity and horizontal pleiotropy, respectively.

RESULTS

According to the results obtained from the IVW model, no compelling evidence was found to support a potential causal association between delirium and PD (IVW: odds ratio [OR]: 0.996, 95% confidence interval CI 0.949-1.043, P = 0.845). Additionally, in the reverse direction, based on the results obtained from the IVW model, no significant evidence was found to support a causal association between PD and delirium (IVW: OR: 1.078, 95%CI  0.960-1.204, P = 0.225). A sensitivity analysis verified the reliability of the results.

CONCLUSION

According to the MR findings, a bidirectional causal relationship between delirium and PD is not observed. It is crucial to conduct further research in clinical practice to investigate the association between delirium and the risk of PD.