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High C-Reactive Protein Predicts Delirium Incidence, Duration, and Feature Severity After Major Noncardiac Surgery
Sarinnapha M Vasunilashorn1,2,3, Simon T Dillon2,4, Sharon K Inouye2,3,5
1Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
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.
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