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

Abstract

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.

Impact of intraoperative dexmedetomidine on postoperative delirium and pro-inflammatory cytokine levels in elderly patients undergoing thoracolumbar compression fracture surgery: A prospective, randomized, placebo-controlled clinical trial

“…[ 26 ] Additionally, evidence suggests that preoperative inflammatory markers, including IL-6, IL-8, IL-10, and IL-1β, as well as TNF-α, are correlated with the occurrence of POD in patients undergoing surgical procedure. [ 27 ] Furthermore, genome-wide DNA methylation profiles have been studied among neurosurgery patients with and without postoperative delirium, demonstrating heightened inflammatory cytokines such as IL‐1β, IL‐6, and TNF-α in the brain following surgical intervention. [ 28 ]…”

“…[26] Additionally, evidence suggests that preoperative inflammatory markers, including IL-6, IL-8, IL-10, and IL-1β, as well as TNF-α, are correlated with the occurrence of POD in patients undergoing surgical procedure. [27] Furthermore, genome-wide DNA methylation profiles have been studied among neurosurgery patients with and without postoperative delirium, demonstrating heightened inflammatory cytokines such as IL-1β, IL-6, and TNF-α in the brain following surgical intervention. [28] These findings collectively emphasize the intricate relationship between inflammatory cytokines and the development of postoperative delirium, shedding light on the potential role of Dexmedetomidine in modulating the inflammatory response and its impact on POD.…”

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

“…Although the correlation between GA exposure and an elevated risk of POD remains controversial [18][19][20][21][22][23] , it is generally believed that GA exposure would lead to an increased risk of POD; however, a large-scale RCT that randomly assigned patients to either GA or spinal anesthesia did not find any difference in the incidence of POD between the two groups 44 , suggesting no causality between GA exposure and the subsequent POD. On the other www.nature.com/scientificreports/ hand, several studies reported an association of a proinflammatory state with the development of POD [45][46][47] , highlighting inflammation as a potential underlying mechanism. Consistently, a previous meta-analysis of 54 observational studies revealed significantly increased circulating C-reactive protein and interleukin-6 concentrations in patients with POD 48 .…”

Inflammatory and nutritional markers predict the risk of post-operative delirium in elderly patients following total hip arthroplasty

“…Regarding CAR, Yang et al indicated that preoperative CAR was not related to the occurrence of POD in cases undergoing lumbar spinal surgery (40). Peng et al found that preoperative CAR was a significant predictor for POD for older patients receiving total joint arthroplasty (41).…”