High C-Reactive Protein Predicts Delirium Incidence, Duration, and Feature Severity After Major Noncardiac Surgery.
High C-Reactive Protein Predicts Delirium Incidence, Duration, and Feature Severity After Major Noncardiac Surgery.
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DOI：
10.1111/jgs.14913
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发表时间：
2017-08
影响因子：
6.3
通讯作者：
Marcantonio ER
中科院分区：
文献类型：
--
作者：
Vasunilashorn SM;Dillon ST;Inouye SK;Ngo LH;Fong TG;Jones RN;Travison TG;Schmitt EM;Alsop DC;Freedman SD;Arnold SE;Metzger ED;Libermann TA;Marcantonio ER
旨在检查术前 (PREOP) 和术后第 2 天 (POD2) 测量的炎症标志物 C 反应蛋白 (CRP) 与谵妄发生率、持续时间和特征严重程度之间的关联。前瞻性队列研究。两个学术医疗中心。接受重大非心脏手术的≥70岁成年人（N=560）。使用ELISA测量血浆CRP。谵妄是通过混乱评估方法（CAM）访谈和图表审查来评估的。谵妄持续时间通过谵妄住院天数来衡量。谵妄特征严重程度定义为所有术后住院日内 CAM-Severity (CAM-S) 评分的总和。我们使用广义线性模型来检查 CRP（分别为 PREOP 和 POD2）与谵妄发生率、持续时间、特征严重程度之间的独立关联；住院时间延长（LOS，>5 天）；和排放处置。 24% 的参与者发生术后谵妄，12% 的谵妄天数≥2 天，平均（标准差）CAM-S 总和为 9.3（11.4）。调整年龄、性别、手术类型、麻醉途径、医疗合并症和术后感染并发症后，PREOP CRP ≥3mg/L 的参与者发生谵妄的风险增加 1.5 倍（95% 置信区间 [CI] 1.1-2.1），谵妄天数增加 0.4 天（p<.001），谵妄更严重（CAM-S 点高 3.6，p<.001）， 1.4 相对于 CRP <3mg/L 的患者，LOS 延长的风险更大（95% CI 1.1-1.8）。使用 POD2 CRP，最高四分位数 (≥235.73mg/L) 的参与者发生谵妄的可能性是最低四分位数参与者的 1.5 倍 (95% CI 1.0–2.4)，谵妄天数多 0.2 天 (p<.05)，并且谵妄更严重 (CAM-S 高 4.5 分，p<.001)。 (≤127.53mg/L)。高 PREOP 和 POD2 CRP 与谵妄发生率、持续时间和特征严重程度独立相关。 CRP 可能有助于识别有谵妄风险的患者。
To examine associations between inflammatory marker C-reactive protein (CRP) measured preoperatively (PREOP) and on postoperative day 2 (POD2) with delirium incidence, duration, and feature severity. Prospective cohort study. Two academic medical centers. Adults aged ≥70 undergoing major non-cardiac surgery (N=560). Plasma CRP was measured using ELISA. Delirium was assessed from Confusion Assessment Method (CAM) interviews and chart review. Delirium duration was measured by number of hospital days with delirium. Delirium feature severity was defined as the sum of CAM-Severity (CAM-S) scores across all postoperative hospital days. We used generalized linear models to examine independent associations between CRP (PREOP and POD2, separately) and delirium incidence, duration, feature severity; prolonged hospital length of stay (LOS, >5 days); and discharge disposition. Postoperative delirium occurred in 24% of participants, 12% had ≥2 delirium days, and the mean(standard deviation) sum CAM-S was 9.3(11.4). After adjusting for age, sex, surgery type, anesthesia route, medical comorbidities, and postoperative infectious complications, participants with PREOP CRP ≥3mg/L had a 1.5 greater risk of delirium (95% confidence interval[CI] 1.1–2.1), 0.4 more delirium days (p<.001), more severe delirium (3.6 CAM-S points higher, p<.001), and a 1.4 greater risk of prolonged LOS (95 % CI 1.1–1.8) relative to patients with CRP <3mg/L. Using POD2 CRP, participants in the highest quartile (≥235.73mg/L) were 1.5 times as likely to develop delirium (95% CI 1.0–2.4), had 0.2 more delirium days (p<.05), and had more severe delirium (4.5 CAM-S points higher, p<.001) than participants in the lowest quartile (≤127.53mg/L). High PREOP and POD2 CRP were independently associated with delirium incidence, duration, and feature severity. CRP may be useful to identify patients at-risk for delirium.
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CAM-S：在2个队列中del妄严重性的新评分系统的开发和验证。
影响因子：
39.2
作者：
Inouye SK;Kosar CM;Tommet D;Schmitt EM;Puelle MR;Saczynski JS;Marcantonio ER;Jones RN
通讯作者：
Jones RN
影响因子：
120.7
作者：
Marcantonio, Edward R.
通讯作者：
Marcantonio, Edward R.
影响因子：
6.3
作者：
Saczynski JS;Kosar CM;Xu G;Puelle MR;Schmitt E;Jones RN;Marcantonio ER;Wong B;Isaza I;Inouye SK
通讯作者：
Inouye SK
影响因子：
168.9
作者：
Inouye, Sharon K.;Westendorp, Rudi G. J.;Saczynski, Jane S.
通讯作者：
Saczynski, Jane S.
DOI：
10.1097/ede.0b013e3181a819a1
发表时间：
2009-07
期刊：
Epidemiology (Cambridge, Mass.)
影响因子：
--
作者：
Schisterman EF;Cole SR;Platt RW
通讯作者：
Platt RW