Preoperative Prognostic Nutritional Index Value is Related to Postoperative Delirium in Elderly Patients After Noncardiac Surgery: A Retrospective Cohort Study

Liu, He; Dai, Ming-Sheng; Guan, Hui-Lian; Gao, Xing; Zhou, Yang; Sun, Xun; Zhou, Jian; Hu, Xiaoyi; Li, Xiang; Yu, Song; Han, Yuan; Cao, Jun-Li

doi:10.2147/rmhp.s280567

Cited by 18 publications

(28 citation statements)

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“…These two markers for recent alcohol intake can be detected in the blood for approximately 10 h after a small to moderate alcohol intake and up to 5 days after large and repeated alcohol intakes [67][68][69]. As the efficacy of these two tests has been demonstrated in multiple settings, it has been also suggested that EtG and EtS should be included in screening tests for injured or atrisk for alcohol abuse people (including pregnant women) to investigate the possible association between residual alcohol effects and injuries, and to verify alcohol abstinence in cases of substance-related disorders [72,73]. In the liver, ethanol is metabolized via oxidative and non-oxidative (less than 1%) ways.…”

Section: Alcohol Abuse Detectionmentioning

confidence: 99%

Alcohol and Head and Neck Cancer: Updates on the Role of Oxidative Stress, Genetic, Epigenetics, Oral Microbiota, Antioxidants, and Alkylating Agents

et al. 2022

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Head and neck cancer (HNC) concerns more than 890,000 patients worldwide annually and is associated with the advanced stage at presentation and heavy outcomes. Alcohol drinking, together with tobacco smoking, and human papillomavirus infection are the main recognized risk factors. The tumorigenesis of HNC represents an intricate sequential process that implicates a gradual acquisition of genetic and epigenetics alterations targeting crucial pathways regulating cell growth, motility, and stromal interactions. Tumor microenvironment and growth factors also play a major role in HNC. Alcohol toxicity is caused both directly by ethanol and indirectly by its metabolic products, with the involvement of the oral microbiota and oxidative stress; alcohol might enhance the exposure of epithelial cells to carcinogens, causing epigenetic modifications, DNA damage, and inaccurate DNA repair with the formation of DNA adducts. Long-term markers of alcohol consumption, especially those detected in the hair, may provide crucial information on the real alcohol drinking of HNC patients. Strategies for prevention could include food supplements as polyphenols, and alkylating drugs as therapy that play a key role in HNC management. Indeed, polyphenols throughout their antioxidant and anti-inflammatory actions may counteract or limit the toxic effect of alcohol whereas alkylating agents inhibiting cancer cells’ growth could reduce the carcinogenic damage induced by alcohol. Despite the established association between alcohol and HNC, a concerning pattern of alcohol consumption in survivors of HNC has been shown. It is of primary importance to increase the awareness of cancer risks associated with alcohol consumption, both in oncologic patients and the general population, to provide advice for reducing HNC prevalence and complications.

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Section: Alcohol Abuse Detectionmentioning

confidence: 99%

Alcohol and Head and Neck Cancer: Updates on the Role of Oxidative Stress, Genetic, Epigenetics, Oral Microbiota, Antioxidants, and Alkylating Agents

et al. 2022

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“… 31 PNI, an indicator representing patients’ nutritional and immune status, is not only verified its association with long-term prognosis, 17 but also involves in the development of POD after non-cardiac surgery. 32 A previous finding indicated that lower PNI could increase the likelihood of developing POD in colorectal surgery. 21 Interestingly, another study noted that there was no association between PNI and POD in abdominal surgery, which might be related to sample size, patient characteristics, types of surgery and diagnostic tools.…”

Section: Discussionmentioning

confidence: 97%

Clinical risk analysis of postoperative delirium in elderly patients undergoing thoracic and abdominal surgery: study protocol of a single-centre observational cohort study

Liu

et al. 2022

BMJ Open

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IntroductionPostoperative delirium (POD) acts as a common complication in older patients after surgery, accompanied by longer recovery time, prolonged hospital stay, increased hospitalisation costs, etc. Therefore, it is urgent to reduce POD by implementing some intervention strategies. Early identification of associated risk factors was regarded as an effective method to lower the incidence of POD. Currently, the incidence and risk factors of POD have been widely investigated in orthopaedic and cardiac surgery, while remain scarce in thoracic and abdominal surgery. We will perform an observational cohort study to explore the incidence and potential risk variables of POD in thoracic and abdominal surgery, mainly focusing on some prognostic indicators including age-adjusted Charlson Comorbidity Index (ACCI), Prognostic Nutrition Index (PNI) and Fibrinogen to Albumin Ratio (FAR). In addition, we will further develop a predictive model based on related data to provide a novel method for preventing POD.Methods and analysisA single-centre observational study is conducted among patients aged ≥60 years old undergoing thoracic and abdominal surgery from 28 February 2022 to 31 December 2022. The patients will be divided into POD group and non-POD group following the Diagnostic and Statistical Manual of Mental Disorders, fifth edition. Related variables mainly including ACCI, PNI and FAR will be analysed by univariate and multivariate logistic regression analyses. Besides, a predictive model will be established according to associated risk factors, and the receiver operating characteristic curve will be used to further evaluate the accuracy of the predictive model.Ethics and disseminationThe study has been approved by the Medical Ethics Committee of Hebei General Hospital (approval number 2022021) and will intend to be published in peer-reviewed journals.Trial registration numberChinese Clinical Trial Registry (ChiCTR2200057126).

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“…Our study reported that the incidence of postoperative delirium was 13.5% in placebo-treated patients and 5.6% in the rosuvastatin group, and the results were similar to those of a large number of previous studies[ 12 , 17 , 20 , 21 ]. Liu et al [ 22 ] performed a retrospective cohort study that included 361 elderly patients and reported that 19.9% of noncardiac surgery individuals developed postoperative delirium after surgery. Kant et al [ 23 ] also conducted a study on 413 patients and reported that the incidence of postoperative delirium was as high as 17%, and preoperative brain magnetic resonance imaging features may indicate a predisposition for developing delirium after major surgery.…”

Section: Discussionmentioning

confidence: 99%

Effects of perioperative rosuvastatin on postoperative delirium in elderly patients: A randomized, double-blind, and placebo-controlled trial

Xu¹,

Luo²,

Li³

et al. 2021

WJCC

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BACKGROUND Experimental evidence has indicated the benefits of statins for the treatment of postoperative delirium. Previously, clinical trials did not reach definite conclusions on the effects of statins on delirium. Some clinical trials have indicated that statins reduce postoperative delirium and improve outcomes, while some studies have reported negative results. AIM To evaluate whether perioperative rosuvastatin treatment reduces the incidence of delirium and improves clinical outcomes. METHODS This randomized, double-blind, and placebo-controlled trial was conducted in a single center in Jiangsu, China. This study enrolled patients aged greater than 60 years who received general anesthesia during elective operations and provided informed consent. A computer-generated randomization sequence (in a 1:1 ratio) was used to randomly assign patients to receive either rosuvastatin (40 mg/d) or placebo. Participants, care providers, and investigators were all masked to group assignments. The primary endpoint was the incidence of delirium, which was assessed twice daily with the Confusion Assessment Method during the first 7 postoperative days. Analyses were performed on intention-to-treat and safety populations. RESULTS Between January 1, 2017 and January 1, 2020, 3512 patients were assessed. A total of 821 patients were randomly assigned to receive either placebo ( n = 411) or rosuvastatin ( n = 410). The incidence of postoperative delirium was significantly lower in the rosuvastatin group [23 (5.6%) of 410 patients] than in the placebo group {42 (13.5%) of 411 patients [odds ratios (OR) = 0.522, 95% confidence interval (CI): 0.308-0.885; P < 0.05]}. No significant difference in 30-d all-cause mortality (6.1% vs 8.7%, OR = 0.67, 95%CI: 0.39-1.2, P = 0.147) was observed between the two groups. Rosuvastatin decreased the hospitalization time (13.8 ± 2.5 vs 14.2 ± 2.8, P = 0.03) and hospitalization expenses (9.3 ± 2.5 vs 9.8 ± 2.9, P = 0.007). No significant differences in abnormal liver enzymes (9.0% vs 7.1%, OR = 1.307, 95%CI: 0.787-2.169, P = 0.30) or rhabdomyolysis (0.73% vs 0.24%, OR = 3.020, 95%CI: 0.31-29.2, P = 0.37) were observed between the two groups. CONCLUSION The current study suggests that perioperative rosuvastatin treatment reduces the incidence of delirium after an elective operation under general anesthesia. However, the evidence does not reveal that rosuvastatin improves clinical outcomes. The therapy is safe. Further investigation is necessary to fully understand the potential usefulness of rosuvastatin in elderly patients...

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Preoperative Prognostic Nutritional Index Value is Related to Postoperative Delirium in Elderly Patients After Noncardiac Surgery: A Retrospective Cohort Study

Cited by 18 publications

References 30 publications

Alcohol and Head and Neck Cancer: Updates on the Role of Oxidative Stress, Genetic, Epigenetics, Oral Microbiota, Antioxidants, and Alkylating Agents

Alcohol and Head and Neck Cancer: Updates on the Role of Oxidative Stress, Genetic, Epigenetics, Oral Microbiota, Antioxidants, and Alkylating Agents

Clinical risk analysis of postoperative delirium in elderly patients undergoing thoracic and abdominal surgery: study protocol of a single-centre observational cohort study

Effects of perioperative rosuvastatin on postoperative delirium in elderly patients: A randomized, double-blind, and placebo-controlled trial

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