An Association Between C-Reactive Protein Levels and the Occurrence of Cognitive Dysfunction After Heart Valve Replacement

Nurcahyo, Widya Istanto; Arifin, Anshoril; Primatika, Aria Dian; Muttaqin, Zainal; Boom, Cindy Elfira; Harahap, Mohamad Sofyan; Mochamat, Mochamat; Nugroho, Taufik Eko; Wicaksono, Satrio Adi

doi:10.2147/vhrm.s334982

Cited by 8 publications

(19 citation statements)

References 35 publications

(34 reference statements)

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“…Tau protein, NfL and more frequently IL-6 have been proposed as strong biomarker candidates due to their well-known association with cognitive decline and the shared characteristics between perioperative disorders, neurodegenerative diseases, and neuronal injury 26 . The stress-immune hypothesis for delirium has also been supported by evidence showing increased levels of cortisol, CRP, TNF-α, IL-2, IL-6, and IL-8 in delirious surgical patients 32,34,[37][38][39][40][41][42] .…”

Section: Discussionmentioning

confidence: 91%

Multivariable model of postoperative delirium in cardiac surgery patients: proteomic and demographic contributions

Gonçalves

Khera

Otu

et al. 2023

Preprint

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Background: Delirium following cardiac surgery is common, morbid, and costly, but may be prevented with risk stratification and targeted intervention. Preoperative protein signatures may identify patients at increased risk for worse postoperative outcomes, including delirium. In this study, we aimed to identify plasma protein biomarkers and develop a predictive model for postoperative delirium in older patients undergoing cardiac surgery, while also uncovering possible pathophysiological mechanisms. Methods: SOMAscan analysis of 1,305 proteins in the plasma from 57 older adults undergoing cardiac surgery requiring cardiopulmonary bypass was conducted to define delirium-specific protein signatures at baseline (PREOP) and postoperative day 2 (POD2). Selected proteins were validated in 115 patients using the ELLA multiplex immunoassay platform. Proteins were combined with clinical and demographic variables to build multivariable models that estimate the risk of postoperative delirium and bring light to the underlying pathophysiology. Results: A total of 666 proteins from SOMAscan analysis were found altered between PREOP and POD2 (Benjamini-Hochberg (BH)-p<0.01). Using these results and findings from other studies, 12 biomarker candidates (Tukey's fold change (|tFC|)>1.4) were selected for ELLA multiplex validation. Eight proteins were significantly altered at PREOP, and seven proteins at POD2 (p<0.05), in patients who developed postoperative delirium compared to non-delirious patients. Statistical analyses of model fit resulted in selecting a combination of age, sex, and different 3-protein biomarker panels highly correlated with delirium at PREOP (angiopoietin-2, ANGPT2; C-C motif chemokine 5, CCL5; and metalloproteinase inhibitor 1, TIMP1; AUC=0.829) and POD2 (lipocalin-2, LCN2; neurofilament light chain, NFL; and CCL5; AUC=0.845). The delirium-associated proteins identified as biomarker candidates are involved with inflammation, glial dysfunction, vascularization, and hemostasis, highlighting the multifactorial pathophysiology of delirium. Conclusion: Our study proposes two models of postoperative delirium that include a combination of older age, female sex, and altered levels of proteins both preoperatively and postoperatively. Our results support the identification of patients at higher risk of developing postoperative delirium after cardiac surgery and provide insights on the underlying pathophysiology. ClinicalTrials.gov (NCT02546765).

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Section: Discussionmentioning

confidence: 91%

Multivariable model of postoperative delirium in cardiac surgery patients: proteomic and demographic contributions

Gonçalves

Khera

Otu

et al. 2023

Preprint

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“…The most used surgical techniques were open-heart CPB [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36]40,41 and OPCAB. 37,38 Only one study 20 reported that the CPB technique is associated with an increased risk of POCD, which aligns with the findings of Sun et al 43 who stated that OPCAB, when compared to CPB, may reduce the risk of POCD.…”

Section: Discussionmentioning

confidence: 99%

“…Two studies excluded females only. 20,21 Regarding the type of surgery, 17 studies (73.9%) reported openheart cardiopulmonary bypass (CPB), [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] two studies (8.6%) noted off-pump coronary artery bypass (OPCAB) 37,38 and two studies (8.6%) reported both OPCAB and CPB. 20,29 Two studies (8.6%) did not report the type of surgical technique.…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

“…In terms of anaesthetic gases, one study 22 used sevoflurane alone for anaesthesia induction, and two studies 21,31 used isoflurane in combination with other agents. Eleven studies used isoflurane 20,21,25,26,[29][30][31]36,[40][41][42] and five studies used sevoflurane 22,23,32,33,37 for maintenance of anaesthesia in combination with other agents.…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

“…Eleven studies (47.8%) did not measure individual domains of cognition and rather reported overall function. 22,23,26,[29][30][31]33,34,36,37,42 Attention, 20,24,25,27,28,32,38,40,41 memory, 20,21,24,27,28,32,35,38,40 processing speed 24,25,37,38,41 and executive functioning 21,24,25,41 were the most frequently reported impaired domains of cognitive function (see Tables S1-S3).…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

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Anaesthesia‐related cognitive dysfunction following cardiothoracic surgery in late middle‐age and younger adults: A scoping review

Varpaei,

Robbins,

Ling

et al. 2023

Nursing in Critical Care

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AimThis review aimed to evaluate factors associated with anaesthesia‐related postoperative cognitive dysfunction (POCD) among adults younger than 65 years who underwent cardiothoracic surgeries.Study DesignA systematic keyword search, following the scoping review framework, was performed in the PubMed and CINAHL databases. Original English‐language studies that included adults younger than 65 years and addressed cognitive function after surgery along with anaesthesia management were included. Retrospective studies, animal research and in vitro and in vivo studies were excluded.ResultsTwenty‐three articles were included (65.2% interventional studies). All studies lacked theoretical or conceptual frameworks. Ketamine's neuroprotective potential is questionable, and intravenous lidocaine may be considered a possible early agent for preventing POCD, but long‐term effectiveness is uncertain. Compared to inhalational anaesthesia, total intravenous anaesthesia (TIVA) may be related to a decreased incidence of POCD. Variation in POCD assessment impacted the lack of homogeneity in obtained data. Moreover, the shorter‐term timing of POCD evaluation such as in early days after surgery could be greatly influenced by medication and delirium.ConclusionAlthough strategies such as TIVA, the use of neuroprotective anaesthetics and comprehensive preoperative assessments are suggested to prevent POCD, this multifactorial phenomenon cannot be explicitly attributed solely to anaesthetics or anaesthesia‐related techniques. Use of standardized, reliable and valid tools for POCD assessment is encouraged for cross‐study comparison.Relevance to Clinical PracticeNurses and certified nurse anaesthetists must be aware of risk factors for postoperative delirium and POCD so they can assess patients before and after surgery. Patients and caregivers need to be educated about cognitive changes after surgery and advised to report them to their health care provider if they occur.

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Postoperative cognitive dysfunction: a concept analysis

Varpaei,

Farhadi,

Mohammadi

et al. 2024

Aging Clin Exp Res

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Background Post-operative cognitive dysfunction (POCD) is a concern for clinicians that often presents post-surgery where generalized anesthesia has been used. Its prevalence ranges from 36.6% in young adults to 42.4% in older individuals. Conceptual clarity for POCD is lacking in the currently body literature. Our two-fold purpose of this concept analysis was to (1) critically appraise the various definitions, while also providing the best definition, of POCD and (2) narratively synthesize the attributes, surrogate or related terms, antecedents (risk factors), and consequences of the concept. Method The reporting of our review was guided by the PRISMA statement and the 6-step evolutionary approach to concept analysis developed by Rodgers. Three databases, including Medline, CINAHL, and Web of Science, were searched to retrieve relevant literature on the concept of POCD. Two independent reviewers conducted abstract and full-text screening, data extraction, and appraisal. The review process yielded a final set of 86 eligible articles. Result POCD was defined with varying severities ranging from subtle-to-extensive cognitive changes (1) affecting single or multiple cognitive domains that manifest following major surgery (2), is transient and reversible, and (3) may last for several weeks to years. The consequences of POCD may include impaired quality of life, resulting from withdrawal from the labor force, increased patients’ dependencies, cognitive decline, an elevated risk of dementia, rising healthcare costs, and eventual mortality. Conclusion This review resulted in a refined definition and comprehensive analysis of POCD that can be useful to both researchers and clinicians. Future research is needed to refine the operational definitions of POCD so that they better represent the defining attributes of the concept.

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An Association Between C-Reactive Protein Levels and the Occurrence of Cognitive Dysfunction After Heart Valve Replacement

Cited by 8 publications

References 35 publications

Multivariable model of postoperative delirium in cardiac surgery patients: proteomic and demographic contributions

Multivariable model of postoperative delirium in cardiac surgery patients: proteomic and demographic contributions

Anaesthesia‐related cognitive dysfunction following cardiothoracic surgery in late middle‐age and younger adults: A scoping review

Postoperative cognitive dysfunction: a concept analysis

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