Preoperative C-Reactive Protein as a Risk Factor for Postoperative Delirium in Elderly Patients Undergoing Laparoscopic Surgery for Colon Carcinoma

Xiao, Dong; Xing, Hailin; Tai, Huiyu; Xie, Gaoqiang

doi:10.1155/2017/5635640

Cited by 35 publications

(51 citation statements)

References 26 publications

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“…These findings add to the limited number of studies investigating the predictive value of pre‐operative CRP for POD and cognitive decline. Our results are consistent with those reported by the SAGES study group and those of Xiang et al, who also observed higher CRP levels before surgery in elderly patients developing POD after non‐cardiac surgery. These recent studies along with our findings represent emerging evidence for the use of CRP as a biomarker to risk stratify patients before surgery.…”

Section: Discussionsupporting

confidence: 93%

“…However, reasonable evidence supports the use of CRP for risk stratification of surgical patients. Both Dillon and Xiang found elevated CRP levels before surgery to be predictive for POD. This was confirmed in a more recent meta‐analysis by Liu et al who identified an association of pre‐operative CRP with POD in non‐cardiac patients compared to cardiac surgery patients.…”

Section: Introductionmentioning

confidence: 99%

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C‐reactive protein for risk prediction of post‐operative delirium and post‐operative neurocognitive disorder

Knaak

Vorderwülbecke

Spies

et al. 2019

Acta Anaesthesiol Scand

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Background: Post-operative delirium (POD) and post-operative neurocognitive disorder (NCD) are frequently seen in the elderly. Development of biomarkers for pre-operative risk prediction is of major relevance. As inflammation present before surgery might predispose to POD and post-operative NCD development, we aim to determine associations between pre-operative C-reactive protein (CRP) and the incidence of POD and post-operative NCD. Methods:In this observational study, we analyzed 314 patients enrolled in the SuDoCo trial, who had a pre-operative CRP measurement the day before surgery.Primary outcomes were POD assessed according DSM-4 from day 1 until day 7 after surgery and post-operative NCD assessed 3 months after surgery. We conducted multivariable logistic regression analysis adjusted for age, sex, randomization, body mass index, MMSE, ASA status, infection/autoimmune disease/malignoma and types of surgery to determine associations between CRP with POD and post-operative NCD, respectively. Results: Pre-operative CRP was independently associated with POD [OR 1.158 (95% CI 1.040, 1.291); P = .008]. Patients with CRP values ≥5 mg/dL had a 4.8-fold increased POD risk [OR 4.771 (95% CI 1.765, 12.899; P = .002)] compared to patients with lower CRP values. However, no association was seen between pre-operative CRP and post-operative NCD [OR 0.552 (95% CI 0.193, 1.581); P = .269].Conclusions: Pre-operative CRP levels were independently associated with POD but not post-operative NCD after three months. Moreover, higher pre-operative CRP levels showed higher risk for POD. This strengthens the role of inflammation in the development of POD. Assessment of CRP before surgery might allow risk stratification of POD.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

C‐reactive protein for risk prediction of post‐operative delirium and post‐operative neurocognitive disorder

Knaak

Vorderwülbecke

Spies

et al. 2019

Acta Anaesthesiol Scand

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“…In contrast to those of elective hip surgery patients, the preoperative serum levels of CRP in patients with hip fracture can not be considered a predisposing risk factor at baseline. This could explain that elevated preoperative serum CRP levels are found as predisposing risk factors for postoperative delirium in cardiovascular, coloncarinoma, and elective orthopedic surgery 13,19,41 but not in patients undergoing surgery for hip fracture. 12,[21][22][23][24] It has been proposed that delirium that develops in the hours after surgery can be distinguished from delirium that develops after a free interval of 24 to 72 hours after surgery.…”

Section: Discussionmentioning

confidence: 99%

The trajectory of C‐reactive protein serum levels in older hip fracture patients with postoperative delirium

Slor

Witlox

Adamis

et al. 2019

Int J Geriat Psychiatry

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Objectives Important precipitating risk factors for delirium such as infections, vascular disorders, and surgery are accompanied by a systemic inflammatory response. Systemic inflammatory mediators can induce delirium in susceptible individuals. Little is known about the trajectory of systemic inflammatory markers and their role in the development and outcome of delirium. Methods This is a prospective cohort study of older patients undergoing acute surgery for hip fracture. Baseline characteristics were assessed preoperatively. During hospital admission, presence of delirium was assessed daily according to the Confusion Assessment Method criteria. This study compared the trajectory of serum levels of the C‐reactive protein (CRP) between people with and without postoperative delirium. Blood samples were taken at baseline and at postoperative day 1 through postoperative day 5. Results Forty‐one out of 121 patients developed postoperative delirium after hip fracture surgery. Longitudinal analysis of the trajectory of serum CRP levels using the Generalized Estimating Equations (GEE) method identified that higher CRP levels were associated with postoperative delirium. CRP levels were higher from postoperative day 2 through postoperative day 5. No significant differences in serum CRP levels were found when we compared patients with short (1‐2 days) and more prolonged delirium (3 days or more). Conclusions Delirium is associated with an increased systemic inflammatory response, and our results suggest that CRP plays a role in the underlying (inflammatory‐vascular) pathological pathway of postoperative delirium.

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“…The operational definition describing delirium is applied to POD when the clinical manifestations of delirium appear after surgical operation. Delirium refers to acutely altered and fluctuating mental status with signs of altered level of consciousness and inability to maintain attention [12][13][14][15][16][17][18][19][20][21][22]. This condition cannot be explained by any other neurocognitive disorder and has a sudden onset.…”

Section: Definitionmentioning

confidence: 99%

“…Surgery-specific risk factors that put patient body at more stressed state include the followings: invasive preoperative preparation (e.g. mechanical enema, nasogastric tube insertion) [13,15], blood transfusions [12,19], greater blood loss [19], crystalloid infusions [19,20], cardiovascular events [20,22], longer operation hours [19], longer hours spent to recover from general anesthesia [18], inflammatory response mediated by proinflammatory cytokines [15], delayed feeding [15], and postoperative analgesic administration [12,15].…”

Section: Pathophysiologymentioning

confidence: 99%

Literature Review of Postoperative Delirium in Geriatric Patients After Elective Gastrointestinal Cancer Surgery

Park¹,

Choi²

2017

jkbns

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Increasing number of older adults are receiving cancer surgeries especially for gastrointestinal cancers, which brings forth attention to age-related postoperative complication prevention. Postoperative delirium (POD) is a common complication that rises after surgical procedures involving general anesthesia, largely in the elderly population. Due to its sudden onset and fluctuating symptoms, POD often goes underdiagnosed and undertreated even though it may lead to various adverse outcomes. POD in GI cancer surgical elderly patients is poorly understood in terms of prevalence, pathophysiology, assessment, treatment and nursing management. We aimed to identify available literature and investigate study results to broaden our understanding of geriatric GI cancer POD. Methods: The search process involved six databases to identify relevant studies abided by inclusion criteria. Results: Eleven studies were selected for this review. Geriatric POD is closely related to frailty and surgical complications. Frailty increases vulnerability to surgical stress and causes cerebral changes that affect stress-regulating neurotransmitter proportions, brain blood flow, vascular density, neuron cell life and intracellular signal transductions. These conditions of frailty result in increased risks of surgical complications such as blood loss, cardiovascular events and inflammation, which all may lead to the POD. Mini Metal State Examination (MMSE), Confusion Assessment Method (CAM) and Delirium Rating Scale-revised-98 (DRS-R-98) are recommended for POD assessment to identify high-risk patients. Conclusion: The POD prevalence ranged from 8.2% to 51.0%. The multifactorial causative mechanism suggests nurses to identify highrisk elderly GI-cancer surgical patients by reviewing patient-specific factors and surgery-specific factors.

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Preoperative C-Reactive Protein as a Risk Factor for Postoperative Delirium in Elderly Patients Undergoing Laparoscopic Surgery for Colon Carcinoma

Cited by 35 publications

References 26 publications

C‐reactive protein for risk prediction of post‐operative delirium and post‐operative neurocognitive disorder

C‐reactive protein for risk prediction of post‐operative delirium and post‐operative neurocognitive disorder

The trajectory of C‐reactive protein serum levels in older hip fracture patients with postoperative delirium

Literature Review of Postoperative Delirium in Geriatric Patients After Elective Gastrointestinal Cancer Surgery

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