Postoperative C-Reactive Protein Predicts Postoperative Delirium in Colorectal Cancer Following Surgery

Overview

Journal Clin Interv Aging

Publisher Dove Medical Press

Specialty Geriatrics

Date 2023 Apr 11

PMID 37038607

Authors

Yan Sun

Hui-Ping Peng

Ting-Ting Wu

Affiliations

Soon will be listed here.

Abstract

Background: Postoperative delirium (POD) is a common complication in operative patients. Neuroinflammation has been reported to be a potential mechanism associated with the development of POD. Identifying available inflammatory markers such as C-reactive protein (CRP) would aid clinicians in early detection of POD. Previous studies have demonstrated that CRP may be a promising predictive marker for POD. Thus, this study aimed to explore the association between CRP and POD among those elderly colorectal cancer (CRC) patients.

Methods: 643 patients with CRC were included in this study. CRP levels were measured before operation and on postoperative day 1. The univariate and multivariate regression analyses were used to identify risk factors for POD.

Results: Of 643 patients with CRC, 112 cases (17.4%) had POD. CRC patients with POD showed older age, higher CRP level on postoperative day 1, and higher percentage of smoking, diabetes mellitus, and chronic obstructive pulmonary disease (COPD) than CRC patients without POD. Preoperative CRP level was not associated with the POD. Univariate and multivariate regression analyses showed that older age (> 70 years), diabetes mellitus, COPD, and higher CRP level on postoperative day 1 (> 48 mg/L) were risk factors for POD in CRC patients.

Conclusion: Postoperative CRP level is an independent indicator for POD among CRC patients, suggesting the predictive role of postoperative CRP levels for POD in elderly CRC patients undergoing surgery.

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References

Thom R, Levy-Carrick N, Bui M, Silbersweig D . Delirium. Am J Psychiatry. 2019; 176(10):785-793. DOI: 10.1176/appi.ajp.2018.18070893. View

Hindiskere S, Kim H, Han I . Postoperative delirium in patients undergoing surgery for bone metastases. Medicine (Baltimore). 2020; 99(20):e20159. PMC: 7254856. DOI: 10.1097/MD.0000000000020159. View

Zhang W, Wang T, Wang G, Yang M, Zhou Y, Yuan Y . Effects of Dexmedetomidine on Postoperative Delirium and Expression of IL-1β, IL-6, and TNF-α in Elderly Patients After Hip Fracture Operation. Front Pharmacol. 2020; 11:678. PMC: 7235357. DOI: 10.3389/fphar.2020.00678. View

Zhang Z, Pan L, Deng H, Ni H, Xu X . Prediction of delirium in critically ill patients with elevated C-reactive protein. J Crit Care. 2013; 29(1):88-92. DOI: 10.1016/j.jcrc.2013.09.002. View

Ritchie C, Newman T, Leurent B, Sampson E . The association between C-reactive protein and delirium in 710 acute elderly hospital admissions. Int Psychogeriatr. 2014; 26(5):717-24. DOI: 10.1017/S1041610213002433. View

Wilson J, Mart M, Cunningham C, Shehabi Y, Girard T, MacLullich A . Delirium. Nat Rev Dis Primers. 2020; 6(1):90. PMC: 9012267. DOI: 10.1038/s41572-020-00223-4. View

Werner M, Wirgenes K, Shadrin A, Lunding S, Rodevand L, Hjell G . Immune marker levels in severe mental disorders: associations with polygenic risk scores of related mental phenotypes and psoriasis. Transl Psychiatry. 2022; 12(1):38. PMC: 8792001. DOI: 10.1038/s41398-022-01811-6. View

van der Wulp K, van Wely M, Schoon Y, Vart P, Olde Rikkert M, Morshuis W . Geriatric assessment in the prediction of delirium and long-term survival after transcatheter aortic valve implantation. J Thorac Cardiovasc Surg. 2020; 161(6):2095-2102.e3. DOI: 10.1016/j.jtcvs.2020.02.076. View

Kotfis K, Slozowska J, Safranow K, Szylinska A, Listewnik M . The Practical Use of White Cell Inflammatory Biomarkers in Prediction of Postoperative Delirium after Cardiac Surgery. Brain Sci. 2019; 9(11). PMC: 6896029. DOI: 10.3390/brainsci9110308. View

10.

Knaak C, Vorderwulbecke G, Spies C, Piper S, Hadzidiakos D, Borchers F . C-reactive protein for risk prediction of post-operative delirium and post-operative neurocognitive disorder. Acta Anaesthesiol Scand. 2019; 63(10):1282-1289. DOI: 10.1111/aas.13441. View

11.

Hsu P, Pan W, Yip B, Chen R, Cheng H, Chuang S . C-Reactive Protein Predicts Incidence of Dementia in an Elderly Asian Community Cohort. J Am Med Dir Assoc. 2017; 18(3):277.e7-277.e11. DOI: 10.1016/j.jamda.2016.12.006. View

12.

Liu X, Yu Y, Zhu S . Inflammatory markers in postoperative delirium (POD) and cognitive dysfunction (POCD): A meta-analysis of observational studies. PLoS One. 2018; 13(4):e0195659. PMC: 5895053. DOI: 10.1371/journal.pone.0195659. View

13.

Hasegawa T, Saito I, Takeda D, Iwata E, Yonezawa N, Kakei Y . Risk factors associated with postoperative delirium after surgery for oral cancer. J Craniomaxillofac Surg. 2015; 43(7):1094-8. DOI: 10.1016/j.jcms.2015.06.011. View

14.

Inouye S, van Dyck C, Alessi C, Balkin S, Siegal A, Horwitz R . Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Intern Med. 1990; 113(12):941-8. DOI: 10.7326/0003-4819-113-12-941. View

15.

Ren Q, Wen Y, Wang J, Yuan J, Chen X, Thapa Y . Elevated Level of Serum C-reactive Protein Predicts Postoperative Delirium among Patients Receiving Cervical or Lumbar Surgery. Biomed Res Int. 2020; 2020:5480148. PMC: 7436286. DOI: 10.1155/2020/5480148. View

16.

Mattison M . Delirium. Ann Intern Med. 2020; 173(7):ITC49-ITC64. DOI: 10.7326/AITC202010060. View

17.

Feng L, Wang Y, Zeng D, Wang M, Duan X . Predictors of cognitive decline in older individuals without dementia: An updated meta-analysis. Ann Clin Transl Neurol. 2023; 10(4):497-506. PMC: 10109353. DOI: 10.1002/acn3.51740. View

18.

Marcantonio E . Delirium in Hospitalized Older Adults. N Engl J Med. 2017; 377(15):1456-1466. PMC: 5706782. DOI: 10.1056/NEJMcp1605501. View

19.

Pinho C, Cruz S, Santos A, Abelha F . Postoperative delirium: age and low functional reserve as independent risk factors. J Clin Anesth. 2015; 33:507-13. DOI: 10.1016/j.jclinane.2015.09.002. View

20.

Slor C, Witlox J, Adamis D, Jansen R, Houdijk A, van Gool W . The trajectory of C-reactive protein serum levels in older hip fracture patients with postoperative delirium. Int J Geriatr Psychiatry. 2019; 34(10):1438-1446. DOI: 10.1002/gps.5139. View