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- Title
High C-Reactive Protein Predicts Delirium Incidence, Duration, and Feature Severity After Major Noncardiac Surgery.
- Authors
Vasunilashorn, Sarinnapha M.; Dillon, Simon T.; Inouye, Sharon K.; Ngo, Long H.; Fong, Tamara G.; Jones, Richard N.; Travison, Thomas G.; Schmitt, Eva M.; Alsop, David C.; Freedman, Steven D.; Arnold, Steven E.; Metzger, Eran D.; Libermann, Towia A.; Marcantonio, Edward R.
- Abstract
Objectives To examine associations between the inflammatory marker C-reactive protein ( CRP) measured preoperatively and on postoperative day 2 ( POD2) and delirium incidence, duration, and feature severity. Design Prospective cohort study. Setting Two academic medical centers. Participants Adults aged 70 and older undergoing major noncardiac surgery (N = 560). Measurements Plasma CRP was measured using enzyme-linked immunosorbent assay. Delirium was assessed from Confusion Assessment Method ( CAM) interviews and chart review. Delirium duration was measured according to number of hospital days with delirium. Delirium feature severity was defined as the sum of CAM-Severity ( CAM-S) scores on all postoperative hospital days. Generalized linear models were used to examine independent associations between CRP (preoperatively and POD2 separately) and delirium incidence, duration, and feature severity; prolonged hospital length of stay ( LOS, >5 days); and discharge disposition. Results Postoperative delirium occurred in 24% of participants, 12% had 2 or more 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 preoperative CRP of 3 mg/L or greater had a risk of delirium that was 1.5 times as great (95% confidence interval ( CI) = 1.1-2.1) as that of those with CRP less than 3 mg/L, 0.4 more delirium days ( P < .001), more-severe delirium (3.6 CAM-S points higher, P < .001), and a risk of prolonged LOS that was 1.4 times as great (95% CI = 1.1-1.8). Using POD2 CRP, participants in the highest quartile (≥235.73 mg/L) were 1.5 times as likely to develop delirium (95% CI = 1.0-2.4) as those in the lowest quartile (≤127.53 mg/L), had 0.2 more delirium days ( P < .05), and had more severe delirium (4.5 CAM-S points higher, P < .001). Conclusion High preoperative and POD2 CRP were independently associated with delirium incidence, duration, and feature severity. CRP may be useful to identify individuals who are at risk of developing delirium.
- Subjects
C-reactive protein; DELIRIUM in old age; DISEASE duration; POSTOPERATIVE period; DISEASE incidence; PREOPERATIVE period; COHORT analysis; RISK of delirium; DIAGNOSIS; ENZYME-linked immunosorbent assay; BIOMARKERS; ACADEMIC medical centers; CONFIDENCE intervals; DELIRIUM; LENGTH of stay in hospitals; LONGITUDINAL method; MEDICAL cooperation; PROBABILITY theory; RESEARCH; RESEARCH funding; SURGICAL complications; SEVERITY of illness index; DATA analysis software; DESCRIPTIVE statistics
- Publication
Journal of the American Geriatrics Society, 2017, Vol 65, Issue 8, pe109
- ISSN
0002-8614
- Publication type
Article
- DOI
10.1111/jgs.14913