Incidence and predictors of postoperative delirium after cytoreduction surgery‐hyperthermic intraperitoneal chemotherapy

Hemmer, Patrick H. J.; Been, Lukas B.; Ginkel, Robert J. van; Bock, Geertruida H. de; Leeuwen, Barbara L. van

doi:10.1002/jso.24811

Cited by 14 publications

(8 citation statements)

References 43 publications

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“…Here we report that the NLR is a highly significant biomarker of delirium which strongly reflects IRS, M1, Th2, Th17, and IRS/CIRS activation and Tcell growth as well. As such, the present study extends previous research that high serum and CSF CRP and an increased NLR in peripheral blood are consistently reported as biomarkers or predictive risk factors of post-operative delirium [17] [19,[57][58][59][60]. Nevertheless, the immune profiles assayed here better predict delirium symptoms than NLR.…”

Section: Discussionsupporting

confidence: 88%

Delirium due to hip fracture is associated with activated immune-inflammatory pathways and a reduction in negative immunoregulatory mechanisms

Thisayakorn

Thipakorn

Tantavisut

et al. 2022

Preprint

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The objectives of this study were to delineate whether delirium is associated with activation of the immune-inflammatory response system (IRS) as indicated by activation of M1, Thelper (Th)1, and Th17 profiles, and/or by reduced activities of the compensatory immunoregulatory system (CIRS), including Th2 and Tregulatory profiles. We recruited 65 elderly patients with a low energy impact hip fracture who underwent hip fracture operation. The CAM-ICU and the Delirium Rating Scale, Revised-98-Thai version (DRS-R-98) were assessed pre-operatively and 1, 2 and 3 days after surgery. Blood samples (day 1 and 2) post-surgery were assayed for cytokines/chemokines using a MultiPlex assay and the neutrophil/lymphocyte ratio. We found that delirium and/or the DRS-R-98 score were associated with IRS activation as indicated by activated M1, Th1, Th17 and T cell growth profiles and by attenuated CIRS functions. The most important IRS biomarkers were CXCL8, interleukin (IL)-6, and tumor necrosis factor-α, and the most important CIRS biomarkers were IL-4 and soluble IL-1 receptor antagonist. We found that 42.5% of the variance in the actual changes in the DRS-R-98 score (averaged from day 1 to day 3) was explained by T cell growth factors, baseline DRS-R-98 scores and age. The pain scores during delirium were significantly and positively associated with CXCL8 and CCL3 and negatively with IL-4 and sIL-1RA. An increase in the NLR reflects overall IRS, M1, Th1, Th17, and Th2 activation. In conclusion, post-hip surgery delirium is associated with activated IRS pathways and appears especially in patients with lowered CIRS functions.

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Section: Discussionsupporting

confidence: 88%

Delirium due to hip fracture is associated with activated immune-inflammatory pathways and a reduction in negative immunoregulatory mechanisms

Thisayakorn

Thipakorn

Tantavisut

et al. 2022

Preprint

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“…11 literatures [ 9 , 15 , 17 , 19 , 21 – 27 ] reported the serum CRP level of POD patients and non-POD patients in the early stage after operation and analyzed the heterogeneity between the literatures in mg/L ( χ 2 = 191.74, P < 0.01). Using the random-effects model and meta-analysis showed that there was a significant difference in serum CRP level between POD patients and non-POD patients after operation [MD = 27.67, 95% CI (12.77, 42.58), Z = 3.64, P = 0.0003], as shown in Figure 3 .…”

Section: Resultsmentioning

confidence: 99%

“…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.…”

Section: Literature Quality Evaluation and Risk Of Biasmentioning

confidence: 99%

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

Huang

Feng

2022

Journal of Environmental and Public Health

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Background. Postoperative delirium (POD) is very common in the elderly surgical population, and its occurrence is associated with multiple factors such as preoperative, intraoperative, and postoperative factors, and the increase of serum inflammatory markers such as C-reactive protein (CRP) and interleukin-6 (IL-6) is considered to be associated with the occurrence of POD, but the results of multiple studies are inconsistent. In this study, we investigated the correlation between inflammatory markers CRP and IL-6 and POD in elderly patients by literature search and meta-analysis. Methods. We searched PubMed, Web of Science, the Cochrane library, Embase, Ovid, and Springer Link for cohort studies or case-control studies that investigated the factors involved in the occurrence of POD, used the Newcastle-Ottawa Scale (NOS) to assess the quality of the selected literature, and combined the differences in serum CRP and IL-6 levels between POD and non-POD patients after surgery to evaluate the predictive value of CRP and IL-6 for the occurrence of POD. Results. This research comprised 16 papers for quantitative analysis, with a total of 2967 patients, 758 with POD and 2209 with non-POD. There were 16 cohort studies (100%) and 0 case-control studies (0%) across all the collected literatures; there were 15 prospective cohort studies and 1 retrospective cohort research. A meta-analysis revealed a statistically significant difference in serum IL-6 levels between POD patients after surgery and non-POD patients [ MD = 115.68 , 95% CI (25.70, 206.66), Z = 2.52 , P = 0.012 ], as well as a statistically significant difference in serum CRP levels [ MD = 27.67 , 95% CI (12.77, 42.58), Z = 3.64 , P = 0.0003 ]. Discussion. Early after surgery, serum IL-6 and CRP levels were considerably higher in POD patients than in non-POD patients, indicating that early serum inflammatory variables are likely to be predictors of POD. After surgery, the levels of the aforementioned inflammatory factors should be actively monitored to forecast the emergence of delirium, and active treatment should be used to limit the creation and release of the aforementioned inflammatory factors.

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“…We were interested to read the article “Incidence and predictors of postoperative delirium after cytoreduction surgery‐hyperthermic intraperitoneal chemotherapy” published in Journal of Surgical Oncology recently, which shows an incidence of 28% of delirium, occurring after cytoreduction surgery‐hyperthermic intraperitoneal chemotherapy (CRS‐HIPEC) and suggests a role for systemic inflammation in the development of postoperative delirium. Although the results were interesting, some methodological issues should be noticed.…”

mentioning

confidence: 99%