C-reactive Protein to Albumin Ratio as A Novel Inflammatory Biomarker for Postoperative Delirium in Patients Undergoing Transcatheter Aortic Valve Replacement

Kalyoncuoğlu, Muhsin; Biter, Halil İbrahim; Durmuş, Gündüz; Baştan, Birgül; Can, Mehmet Mustafa

doi:10.4274/haseki.galenos.2020.5665

Cited by 5 publications

(7 citation statements)

References 36 publications

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“…The valve and anesthesia comparisons were published separately in two journals, 12,13 and both were included as a complete study in the meta‐analysis. The majority of the included studies were observational (33 prospective studies, 14–46 28 retrospective studies, 47–74 and 4 studies with unknown nature 75–78 ), with only four RCTs 12,13,79–81 . The number of included patients varied widely, ranging from 25 to 170,521 per study.…”

Section: Resultsmentioning

confidence: 99%

Postoperative delirium after transcatheter aortic valve replacement: An updated systematic review and meta‐analysis

Chu

Han

et al. 2022

J American Geriatrics Society

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Aims To perform an updated systematic review and meta‐analysis of postoperative delirium (POD) after transcatheter aortic valve replacement (TAVR). Methods We conducted a systematic literature search of PubMed, Embase, and Cochrane Library databases from the time of the first human TAVR procedure in 2002 until December 24, 2021, which was supplemented by manual searches of bibliographies. Data were collected on incidence rates, risk factors, and/or associated mortality of POD after TAVR. Pooled analyses were conducted using random effects models to yield mean differences, odds ratios, hazard ratios, and risk ratios, with 95% confidence intervals. Results A total of 70 articles (69 studies) comprising 413,389 patients were included. The study heterogeneity was substantial. The pooled mean incidence of POD after TAVR in all included studies was 9.8% (95% CI: 8.7%–11.0%), whereas that in studies using validated tools to assess for delirium at least once a day for at least 2 consecutive days after TAVR was 20.7% (95% CI: 17.8%–23.7%). According to the level of evidence and results of meta‐analysis, independent preoperative risk factors with a high level of evidence included increased age, male sex, prior stroke or transient ischemic attack, atrial fibrillation/flutter, weight loss, electrolyte abnormality, and impaired Instrumental Activities of Daily Living; intraoperative risk factors included non‐transfemoral access and general anesthesia; and acute kidney injury was a postoperative risk factor. POD after TAVR was associated with significantly increased mortality (pooled unadjusted RR: 2.20, 95% CI: 1.79–2.71; pooled adjusted RR: 1.62, 95% CI: 1.25–2.10), particularly long‐term mortality (pooled unadjusted HR: 2.84, 95% CI: 1.91–4.23; pooled adjusted HR: 1.88, 95% CI: 1.30–2.73). Conclusions POD after TAVR is common and is associated with an increased risk of mortality. Accurate identification of risk factors for POD after TAVR and implementation of preventive measures are critical to improve prognosis.

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Section: Resultsmentioning

confidence: 99%

Postoperative delirium after transcatheter aortic valve replacement: An updated systematic review and meta‐analysis

Chu

Han

et al. 2022

J American Geriatrics Society

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“…The preoperative CAR level (OR: 3.04) was an independent risk factor for POD in elderly subjects undergoing total joint arthroplasty [ 49 ]. In another retrospective study, patients undergoing transcatheter aortic valve replacement were analyzed and the CAR was a promising inflammatory parameter to predict POD [ 50 ]. As few studies have been performed on the association between the CAR and POD, more research is needed before clinical applications.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Inflammatory Markers and the Risk of Postoperative Delirium in Patients Undergoing Lumbar Spinal Fusion Surgery

Yang

Lee

Kwon

et al. 2022

JCM

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We investigated the possible associations between postoperative delirium (POD) and routinely available preoperative inflammatory markers in patients undergoing lumbar spinal fusion surgery (LSFS) to explore the role of neuroinflammation and oxidative stress as risk factors for POD. We analyzed 11 years’ worth of data from the Smart Clinical Data Warehouse. We evaluated whether preoperative inflammatory markers, such as the neutrophil-to-lymphocyte ratio (NLR), the monocyte-to-lymphocyte ratio (MLR), and the CRP-to-albumin ratio (CAR), affected the development of POD in patients undergoing LSFS. Of the 3081 subjects included, 187 (7.4%) developed POD. A significant increase in NLR, MLR, and CAR levels was observed in POD patients (p < 0.001). A multivariate analysis showed that the second, third, and highest quartiles of the NLR were significantly associated with the development of POD (adjusted OR (95% CI0: 2.28 (1.25–4.16], 2.48 (1.3–4.73], and 2.88 (1.39–5.96], respectively). A receiver operating characteristic curve analysis showed that the discriminative ability of the NLR, MLR, and CAR for predicting POD was low, but almost acceptable (AUC (95% CI]: 0.60 (0.56–0.64], 0.61 (0.57–0.65], and 0.63 (0.59–0.67], respectively, p < 0.001). Increases in preoperative inflammatory markers, particularly the NLR, were associated with the development of POD, suggesting that a proinflammatory state is a potential pathophysiological mechanism of POD.

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“…1). Finally, 17 articles published between 2015 and 2021 were deemed eligible for the current meta-analysis 14,15,[26][27][28][31][32][33][34][35][36][37][38][39][40][41][42] . Figure 1 summarized the process to identify studies.…”

Section: Study Selection and Qualitymentioning

confidence: 99%

“…Characteristics of the 17 included studies with a total of 10,678 patients receiving TAVR are shown in Table 1. Of the 17 studies, 13 adopted a retrospective design 14,26,[31][32][33][34][35][36][37][38][39][40]42 , three used a prospective design 15,27,41 , and one was a RCT 28 . The mean age of the patients ranged from 74.68 to 85 years, with a male gender distribution ranging from 36.9 to 65%.…”

Section: Study Selection and Qualitymentioning

confidence: 99%

“…There was a wide variation in sample size across the included studies (range: 78 to 5248 patients). The information on body mass index (range: 23.18 to 28.4 kg/m 2 ) was available in 12 studies, while it was unavailable in the other five studies 15,26,38,39,41 . Of 17 studies, 10 used validated methods for POD diagnosis 14,15,[26][27][28]31,[38][39][40][41] , namely the CAM, CAM-ICU, NU-DESC, DSM IV, and DSM V. Five studies did not report the diagnostic measures for POD [32][33][34]36,42 , and the two remaining studies based their diagnosis of POD on clinical symptoms (e.g., any acute disturbance of consciousness with decreased attention) 35 or chart-based delirium identification instrument 37 , respectively.…”

Section: Study Selection and Qualitymentioning

confidence: 99%

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Association of general anesthesia exposure with risk of postoperative delirium in patients receiving transcatheter aortic valve replacement: a meta-analysis and systematic review

Ko,

Hung,

Chang

et al. 2023

Sci Rep

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The aim of this meta-analysis was to assess the association of general anesthesia (GA) exposure with the risk of POD in this patient population. Databases including Medline, EMBASE, Cochrane library, and Google Scholar were searched from inception to December 2022. Analysis of 17 studies published between 2015 and 2021 involving 10,678 individuals revealed an association of GA exposure with an elevated risk of POD [odd ratio (OR) = 1.846, 95% CI 1.329 to 2.563, p = 0.0003, I2 = 68.4%, 10,678 patients]. Subgroup analysis of the diagnostic methods also demonstrated a positive correlation between GA exposure and POD risk when validated methods were used for POD diagnosis (OR = 2.199, 95% CI 1.46 to 3.31, p = 0.0002). Meta-regression analyses showed no significant impact of age, male proportion, and sample size on the correlation between GA and the risk of POD. The reported overall incidence of POD from the included studies regardless of the type of anesthesia was between 0.8 and 27%. Our meta-analysis showed a pooled incidence of 10.3% (95% CI 7% to 15%). This meta-analysis suggested an association of general anesthesia with an elevated risk of postoperative delirium, implying the necessity of implementing appropriate prophylactic strategies against this complication when general anesthesia was used in this clinical setting.

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C-reactive Protein to Albumin Ratio as A Novel Inflammatory Biomarker for Postoperative Delirium in Patients Undergoing Transcatheter Aortic Valve Replacement

Cited by 5 publications

References 36 publications

Postoperative delirium after transcatheter aortic valve replacement: An updated systematic review and meta‐analysis

Postoperative delirium after transcatheter aortic valve replacement: An updated systematic review and meta‐analysis

Preoperative Inflammatory Markers and the Risk of Postoperative Delirium in Patients Undergoing Lumbar Spinal Fusion Surgery

Association of general anesthesia exposure with risk of postoperative delirium in patients receiving transcatheter aortic valve replacement: a meta-analysis and systematic review

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