C-reactive Protein Predicts Postoperative Delirium Following Vascular Surgery
C-reactive Protein Predicts Postoperative Delirium Following Vascular Surgery
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DOI：
10.1016/j.avsg.2014.07.004
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发表时间：
2014-11-01
影响因子：
1.5
通讯作者：
Zeebregts, Clark J.
中科院分区：
文献类型：
--
作者：
Pol, Robert A.;van Leeuwen, Barbara L.;Zeebregts, Clark J.
背景：血管手术后谵妄（POD）的病因通常是未知的。然而，发病率可高达35%。一个可能的神经炎症性谵妄的基础是可能的和C-反应蛋白（CRP）作为炎症的标志物可能发挥预测作用：2010年3月至2012年9月，277例连续择期血管手术患者进行了前瞻性评估POD的诊断。各种潜在的危险因素，包括术后CRP值，collected.Results：患者的平均年龄为69 +/- 11岁（范围21-92）。平均住院时间为6 +/- 4天（范围1-33）。16例患者（6%）在住院期间发生POD。单变量分析显示多种合并症（P = 0.001）、术后CRP水平升高（P = 0.001）、入住重症监护室（P = 0.01）和开放性主动脉手术或截肢术（P = 0.0001）与POD诊断显著相关。多变量logistic回归分析证实了CRP值升高与POD之间的关系（比值比[OR] 1.01，95%置信区间1.00-1.03，P = 0.04）。敏感性分析得出了基本相似的结果。基于OR，可以计算出，如果CRP浓度为50 mg/L，POD的风险增加约35%，如果CRP浓度为100 mg/L，POD的风险增加约90%（与CRP浓度为5 mg/L相比）。31%（5/16）的POD患者在出院后需要长期护理设施（P = 0.0001）。结论：在这项研究中，CRP可以作为血管手术后POD风险增加的标志物。此外，还发现POD与出院后长期护理需求增加10倍相关。
Background: The etiology of postoperative delirium (POD) following vascular surgery is generally unknown. The incidence, however, can be as high as 35%. A possible neuroinflammatory basis for delirium is likely and C-reactive protein (CRP) as a marker for inflammation can possibly play a predictive role.Methods: Between March 2010 and September 2012, 277 consecutive elective vascular surgery patients were prospectively evaluated for the diagnosis of POD. Various potential risk factors, including postoperative CRP values, were collected.Results: The mean age of the patients was 69 +/- 11 years (range 21-92). The mean hospital length of stay was 6 +/- 4 days (range 1-33). Sixteen patients (6%) developed POD during hospital stay. Univariate analysis revealed multiple comorbidities (P = 0.001), postoperative elevated CRP levels (P = 0.001), intensive care unit admittance (P = 0.01), and open aortic surgery or amputation procedures (P = 0.0001) to be significantly related to the diagnosis POD. Multivariate logistic regression analysis confirmed the relationship between an elevated CRP value and POD (odds ratio [OR] 1.01, 95% confidence interval 1.00-1.03, P = 0.04). The sensitivity analyses yielded essentially similar results. Based on OR, it can be calculated that the risk of POD is increased by approximately 35% if the CRP concentration is 50 mg/L, and by approximately 90% if the CRP concentration is 100 mg/L (compared with a CRP concentration of 5 mg/L). Thirty-one percent (5/16) of patients with POD needed a long-stay care facility after discharge (P = 0.0001).Conclusions: In this study, CRP can be used as a marker for an increased risk of POD after vascular surgery. In addition, it was found that POD was associated with a 10-fold increase in the need of long-stay care after discharge.