Elevated Level of Serum C-reactive Protein Predicts Postoperative Delirium among Patients Receiving Cervical or Lumbar Surgery

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.

Predisposing and Precipitating Factors Associated With Delirium

“…Reasons for exclusion were no diagnosis by physician or research personnel (428 studies), no characterization of predisposing or precipitating factors (338 studies), retrospective study design (86 studies), not diagnosed by reference standard (108 studies), no multivariable model (43 studies), delirium assessment not conducted in person (25 studies), not cohort or case-control design (20 studies), sample included less than 50 patients (12 studies), abstract only (18 studies), cohort previously reported (3 studies), and pediatric population (1 studies). Ultimately, 315 studies…”

“…Studies were conducted in 40 different countries, with the plurality in the United States (86 studies [27.3%]), followed by China (48 studies [15.2%]) and the Netherlands (24 studies [7.6%]). Most studies were prospective cohort studies (296 studies…”

“…Delirium was measured by research personnel in 171 studies (54.3%), a combination of research personnel and physicians in 5 studies (1.6%), and a physician in 139 studies …”

Risk Factors and a Nomogram Model Establishment for Postoperative Delirium in Elderly Patients Undergoing Arthroplasty Surgery: A Single-Center Retrospective Study

“…We speculate that this is due to the fact that we use the PSM method to control the confounding factors and eliminate the interference [ 29 ]. In the study of Ren et al, they found that the increase of CRP is the independent risk of POD [ 30 ]; the difference is that they use the change of CRP (values of serum CRP between before and after surgery) as a variable, rather than a simple preoperative CRP value. We believe that the cause of POD should be the increasing inflammatory reaction during operation, not the inflammatory state before operation, and some studies have also found proinflammatory factors in the cerebrospinal fluid of patients with postoperative delirium [ 31 ], so the increase of preoperative CRP (or ESR) does not prove that patients have the risk of POD, but attention should be paid to the dynamic fluctuation of inflammatory indexes in perioperative patients.…”

[Retracted] Correlation Analysis of Inflammatory Markers CRP and IL‐6 and Postoperative Delirium (POD) in Elderly Patients: A Meta‐Analysis of Observational Studies

“…Literature Quality and Bias Evaluation. In this study, the cases included in the literatures [9,10,[14][15][16][17][18][19][20][21][22][23][24][25][26][27] were representative, the potential risk of bias was small, and some literatures did not describe the dropout cases in detail [22,23], but the overall quality score of all literatures was 7-9 points, with good quality, as shown in Table 2.…”