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

Abstract

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.

Delirium, insulin-like growth factor I, growth hormone in older inpatients

“…In addition those studies in surgery wards have examined patients before and immediately after the surgery for delirium. However, it has been suggested that perhaps different mechanisms are underline the delirium that developed in the first 24 hours after surgery and in the delirium that developed the next one to three days after surgery[ 44 ]. Finally one important reason which can explain those discrepancies is the different scales/measurements/criteria that have been applied to define delirium.…”

Impact of Delirium on Short-term Prognosis in Geriatric Patients with Hip Fracture

“…Compared with some research hotspots such as deep vein thrombosis, pulmonary embolism, and cardiovascular and cerebrovascular diseases of the lower extremities, POD is a common phenomenon, but it is easily ignored by orthopedic surgeons in elderly patients with hip fractures. Probably because POD is often an acute transient abnormality, resulting in missed diagnosis and misdiagnosis, which may lead to patients not receiving timely, reasonable, and effective intervention 6,[11][12][13] . In this study, we found that POD may be associated with a series of early adverse prognoses.…”

“…Therefore, POD needs to be treated as soon as possible to be corrected in time. Previous studies reported that delirium results from the combined effects of environmental, pathological, and physiological factors 6,11,12 . Thus, early treatment should not just be symptomatic use of antipsychotic drugs such as haloperidol, olanzapine, and aripiprazole, but should also involve etiological treatments to reduce pain and suffering, correct hypoproteinemia and anemia, restore water and electrolyte balance, provide adequate oxygen inhalation and nutritional support, ensure good sleep, and allow patients to carry out early functional exercises.…”

“…Postoperative delirium (POD) is a common clinical manifestation that occurs in 13-51% of elderly patients with hip fractures 4,5 . Several studies have demonstrated a correlation between POD and length of stay (LOS), as well as hospital costs [6][7][8] . Recently Hamilton et al reported that POD could increase the postoperative mortality of patients who underwent non-cardiac surgery 9 .…”

Association between increased neutrophil-to-lymphocyte ratio and postoperative delirium in elderly patients with total hip arthroplasty for hip fracture

“…The scientific studies showed that certain inflammatory markers are associated with POD [12,13], but they may be excluded in clinical practice due to cost or cumbersome diagnostic procedures. There are relatively few studies devoted to association serum biomarkers with POD [12,14].…”