Abstract
Objective To explore the relationship between elevated serum C-reactive protein (CRP) level and postoperative delirium (POD). Methods 206 patients scheduled to receive cervical or lumbar vertebra surgery under general anesthesia for more than 2 hours in a single medical center were observed and analyzed. Patients' serum CRP, delirious status (using the confusion assessment method (CAM)), and delirious score (using the memorial delirium assessment scale (MDAS)) were examined before surgery and 1-2 days after surgery. The association of a serum CRP elevation value from before to after surgery (D-CRP) with delirium occurrence within 2 days after surgery was assessed with a binary logistic regression model, while the association of D-CRP with the postoperative delirious score was assessed with a linear regression model. The effect of D-CRP on predicting delirium occurrence was evaluated with the area under the receiver operating characteristic (ROC) curve (AUC). Results D-CRP was significantly positively associated with postoperative delirium occurrence (OR = 1.047, 95%CI = 1.013, 1.082), and D-CRP was also significantly linearly associated with the postoperative delirious score (β = 0.014, 95%CI = 0.006, 0.023). AUC of ROC was 0.711 (P = 0.014), suggesting that D-CRP had moderate efficacy on predicting postoperative delirium occurrence (P < 0.05). Conclusions Elevated serum CRP after surgery may be a risk factor for and a predictor of postoperative delirium.
Highlights
Postoperative delirium (POD) is a common complication of the central nerve system after surgical operations in elderly patients, usually characterized by a fluctuating course of altered consciousness, disordered thinking, and inattention [1]
POD is one of the key manifestations of perioperative neurocognitive disorders (PND) [24]. It is a common early postoperative complication of the central nervous system which often occurs within 7 days after surgery
Its occurrence is highly related to the occurrence of postoperative cognitive dysfunction (POCD), with an increase in mortality [2, 25]
Summary
Postoperative delirium (POD) is a common complication of the central nerve system after surgical operations in elderly patients, usually characterized by a fluctuating course of altered consciousness, disordered thinking, and inattention [1]. Compared to other major complications after major surgeries, delirium occurs more frequently and has a greater significance at the population level [3]. Accumulating evidence suggests that delirium itself might lead to permanent cognitive decline and dementia in some patients [4]. It is well established that surgeries, especially major surgeries, are associated with significant system inflammation. It has been evidenced that central nervous system inflammation is associated with POD, the pathogenesis was not fully elucidated [6]
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