White-Cell Derived Inflammatory Biomarkers in Prediction of Postoperative Delirium in Elderly Patients Undergoing Surgery for Lower Limb Fracture Under Non-General Anaesthesia
Xiaowei Li,1,2 Gongming Wang,2 Yingxue He,2 Zhun Wang,1 Mengyuan Zhang1,2 1Department of Anesthesiology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250021, People’s Republic of China; 2Department of Anesthesiology, Shandong Provincial Hospital Af...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Dove Medical Press
2022-04-01
|
| Series: | Clinical Interventions in Aging |
| Subjects: | |
| Online Access: | https://www.dovepress.com/white-cell-derived-inflammatory-biomarkers-in-prediction-of-postoperat-peer-reviewed-fulltext-article-CIA |
| _version_ | 1818394276908761088 |
|---|---|
| author | Li X Wang G He Y Wang Z Zhang M |
| author_facet | Li X Wang G He Y Wang Z Zhang M |
| author_sort | Li X |
| collection | DOAJ |
| description | Xiaowei Li,1,2 Gongming Wang,2 Yingxue He,2 Zhun Wang,1 Mengyuan Zhang1,2 1Department of Anesthesiology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250021, People’s Republic of China; 2Department of Anesthesiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, People’s Republic of ChinaCorrespondence: Mengyuan Zhang, Department of Anesthesiology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250021, People’s Republic of China, Tel +8668776472, Email myzsdslyy@126.comPurpose: The aim of this study was to investigate whether white-cell derived biomarkers could serve as potential markers in prediction of postoperative delirium (POD) after lower limb fracture.Patients and Methods: Elderly patients with surgery for lower limb fracture under non-general anaesthesia were included. Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and platelet-to-white cell ratio (PWR), which were most recently measured preceding surgery and measured within 24h after surgery, were calculated. Delirium was measured with Confusion Assessment Method (CAM) once daily from preoperative day 1 to postoperative day 3 or hospital discharge.Results: The incidence of POD was 32.6% (60/184). Between patients with and those without POD, there were significant differences in preoperative hematological biomarkers (neutrophil count, lymphocyte count, NLR and PWR) and postoperative hematological biomarkers (white cell count, neutrophil count, lymphocyte count, NLR, PLR and PWR). More obvious changes before and after operation for NLR, PLR and C-reactive protein (CRP) were found in patients with POD. Multivariate logistic regression showed that benzodiazepines (OR, 7.912; 95% CI, 1.884– 33.230; p = 0.005), change of CRP (OR, 1.017; 95% CI, 1.007– 1.027; p = 0.001) and postoperative NLR (OR, 1.358; 95% CI, 1.012– 1.823; p = 0.041) were associated with POD. When the changes of NLR, PLR and PWR entered multivariate logistic regression, older age (OR, 1.073; 95% CI, 1.001– 1.149; p = 0.046), benzodiazepines (OR, 6.811; 95% CI, 1.652– 28.081; p = 0.008), greater change of CRP (OR, 1.015; 95% CI, 1.006– 1.023; p = 0.001) and greater change of NLR (OR, 1.266; 95% CI, 1.035– 1.549; p = 0.022) were associated with increased risk of POD. Postoperative NLR had high accuracy to predict POD with area under curve (AUC) of 0.790 (95% CI 0.708 to 0.872).Conclusion: Age, benzodiazepines, postoperative NLR, change of NLR and change of CRP were independent predictable markers for POD in elderly patients undergoing surgery for lower limb fracture under non-general anaesthesia. Early postoperative NLR may help to recognize POD as soon as possible.Keywords: postoperative delirium, anaesthesia method, inflammation, neutrophil-to-lymphocyte ratio, lower limb fracture |
| first_indexed | 2024-12-14T05:58:38Z |
| format | Article |
| id | doaj.art-d403d8bdf2424893b6eeec3f1a9998da |
| institution | Directory Open Access Journal |
| issn | 1178-1998 |
| language | English |
| last_indexed | 2024-12-14T05:58:38Z |
| publishDate | 2022-04-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Clinical Interventions in Aging |
| spelling | doaj.art-d403d8bdf2424893b6eeec3f1a9998da2022-12-21T23:14:30ZengDove Medical PressClinical Interventions in Aging1178-19982022-04-01Volume 1738339274174White-Cell Derived Inflammatory Biomarkers in Prediction of Postoperative Delirium in Elderly Patients Undergoing Surgery for Lower Limb Fracture Under Non-General AnaesthesiaLi XWang GHe YWang ZZhang MXiaowei Li,1,2 Gongming Wang,2 Yingxue He,2 Zhun Wang,1 Mengyuan Zhang1,2 1Department of Anesthesiology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250021, People’s Republic of China; 2Department of Anesthesiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, People’s Republic of ChinaCorrespondence: Mengyuan Zhang, Department of Anesthesiology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250021, People’s Republic of China, Tel +8668776472, Email myzsdslyy@126.comPurpose: The aim of this study was to investigate whether white-cell derived biomarkers could serve as potential markers in prediction of postoperative delirium (POD) after lower limb fracture.Patients and Methods: Elderly patients with surgery for lower limb fracture under non-general anaesthesia were included. Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and platelet-to-white cell ratio (PWR), which were most recently measured preceding surgery and measured within 24h after surgery, were calculated. Delirium was measured with Confusion Assessment Method (CAM) once daily from preoperative day 1 to postoperative day 3 or hospital discharge.Results: The incidence of POD was 32.6% (60/184). Between patients with and those without POD, there were significant differences in preoperative hematological biomarkers (neutrophil count, lymphocyte count, NLR and PWR) and postoperative hematological biomarkers (white cell count, neutrophil count, lymphocyte count, NLR, PLR and PWR). More obvious changes before and after operation for NLR, PLR and C-reactive protein (CRP) were found in patients with POD. Multivariate logistic regression showed that benzodiazepines (OR, 7.912; 95% CI, 1.884– 33.230; p = 0.005), change of CRP (OR, 1.017; 95% CI, 1.007– 1.027; p = 0.001) and postoperative NLR (OR, 1.358; 95% CI, 1.012– 1.823; p = 0.041) were associated with POD. When the changes of NLR, PLR and PWR entered multivariate logistic regression, older age (OR, 1.073; 95% CI, 1.001– 1.149; p = 0.046), benzodiazepines (OR, 6.811; 95% CI, 1.652– 28.081; p = 0.008), greater change of CRP (OR, 1.015; 95% CI, 1.006– 1.023; p = 0.001) and greater change of NLR (OR, 1.266; 95% CI, 1.035– 1.549; p = 0.022) were associated with increased risk of POD. Postoperative NLR had high accuracy to predict POD with area under curve (AUC) of 0.790 (95% CI 0.708 to 0.872).Conclusion: Age, benzodiazepines, postoperative NLR, change of NLR and change of CRP were independent predictable markers for POD in elderly patients undergoing surgery for lower limb fracture under non-general anaesthesia. Early postoperative NLR may help to recognize POD as soon as possible.Keywords: postoperative delirium, anaesthesia method, inflammation, neutrophil-to-lymphocyte ratio, lower limb fracturehttps://www.dovepress.com/white-cell-derived-inflammatory-biomarkers-in-prediction-of-postoperat-peer-reviewed-fulltext-article-CIApostoperative deliriumanaesthesia methodinflammationneutrophil-to-lymphocyte ratiolower limb fracture |
| spellingShingle | Li X Wang G He Y Wang Z Zhang M White-Cell Derived Inflammatory Biomarkers in Prediction of Postoperative Delirium in Elderly Patients Undergoing Surgery for Lower Limb Fracture Under Non-General Anaesthesia Clinical Interventions in Aging postoperative delirium anaesthesia method inflammation neutrophil-to-lymphocyte ratio lower limb fracture |
| title | White-Cell Derived Inflammatory Biomarkers in Prediction of Postoperative Delirium in Elderly Patients Undergoing Surgery for Lower Limb Fracture Under Non-General Anaesthesia |
| title_full | White-Cell Derived Inflammatory Biomarkers in Prediction of Postoperative Delirium in Elderly Patients Undergoing Surgery for Lower Limb Fracture Under Non-General Anaesthesia |
| title_fullStr | White-Cell Derived Inflammatory Biomarkers in Prediction of Postoperative Delirium in Elderly Patients Undergoing Surgery for Lower Limb Fracture Under Non-General Anaesthesia |
| title_full_unstemmed | White-Cell Derived Inflammatory Biomarkers in Prediction of Postoperative Delirium in Elderly Patients Undergoing Surgery for Lower Limb Fracture Under Non-General Anaesthesia |
| title_short | White-Cell Derived Inflammatory Biomarkers in Prediction of Postoperative Delirium in Elderly Patients Undergoing Surgery for Lower Limb Fracture Under Non-General Anaesthesia |
| title_sort | white cell derived inflammatory biomarkers in prediction of postoperative delirium in elderly patients undergoing surgery for lower limb fracture under non general anaesthesia |
| topic | postoperative delirium anaesthesia method inflammation neutrophil-to-lymphocyte ratio lower limb fracture |
| url | https://www.dovepress.com/white-cell-derived-inflammatory-biomarkers-in-prediction-of-postoperat-peer-reviewed-fulltext-article-CIA |
| work_keys_str_mv | AT lix whitecellderivedinflammatorybiomarkersinpredictionofpostoperativedeliriuminelderlypatientsundergoingsurgeryforlowerlimbfractureundernongeneralanaesthesia AT wangg whitecellderivedinflammatorybiomarkersinpredictionofpostoperativedeliriuminelderlypatientsundergoingsurgeryforlowerlimbfractureundernongeneralanaesthesia AT hey whitecellderivedinflammatorybiomarkersinpredictionofpostoperativedeliriuminelderlypatientsundergoingsurgeryforlowerlimbfractureundernongeneralanaesthesia AT wangz whitecellderivedinflammatorybiomarkersinpredictionofpostoperativedeliriuminelderlypatientsundergoingsurgeryforlowerlimbfractureundernongeneralanaesthesia AT zhangm whitecellderivedinflammatorybiomarkersinpredictionofpostoperativedeliriuminelderlypatientsundergoingsurgeryforlowerlimbfractureundernongeneralanaesthesia |