In:
Journal of the American Geriatrics Society, Wiley, Vol. 65, No. 8 ( 2017-08)
Abstract:
To examine associations between the inflammatory marker C‐reactive protein ( CRP ) measured preoperatively and on postoperative day 2 ( POD 2) 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 POD 2 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 POD 2 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 POD 2 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.
Type of Medium:
Online Resource
ISSN:
0002-8614
,
1532-5415
DOI:
10.1111/jgs.2017.65.issue-8
Language:
English
Publisher:
Wiley
Publication Date:
2017
detail.hit.zdb_id:
2040494-3
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