Influence of the postoperative inflammatory response on cognitive decline in elderly patients undergoing on-pump cardiac surgery: a controlled, prospective observational study

BMC Anesthesiology

Research Article

Kristof Racz¹  Endre Nemeth¹  Klara I. Ronkay¹  Janos Gal¹  Fumiko P. Hamvas¹  Kinga B. Koritsanszky¹  Ajandek Eory²  Bela Merkely³  Katalin Vig³  Csaba Borbély⁴ 

[1] Department of Anaesthesia and Intensive Therapy, Semmelweis University, P.O.B. 2, H-1428, Budapest, Hungary;Department of Family Medicine, Semmelweis University, P.O.B. 2, H-1428, Budapest, Hungary;Heart and Vascular Centre, Semmelweis University, P.O.B. 2, H-1428, Budapest, Hungary;National Institute of Neuroscience, Amerikai Street 57, H-1145, Budapest, Hungary;

关键词: Cardiac surgery;    Cardiopulmonary bypass;    Procalcitonin;    C-reactive protein;    Postoperative cognitive dysfunction;    Reliable Change Index;   

DOI  :  10.1186/s12871-017-0408-1

 received in 2017-04-06, accepted in 2017-08-22,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundThe role of non-infective inflammatory response (IR) in the aetiology of postoperative cognitive dysfunction (POCD) is still controversial. The aim of this controlled, prospective observational study was to assess the possible relationship between the grade of IR, defined by procalcitonin (PCT) changes, and development of POCD related to cardiac surgery.MethodsForty-two patients, who were ≥ 60 years of age and scheduled for elective cardiac surgery, were separated into the low inflammatory (LIR) and high inflammatory (HIR) response groups based on their PCT levels measured on the first postoperative day. A matched normative control group of 32 subjects was recruited from primary care practice. The PCT and C-reactive protein (CRP) levels were monitored daily during the first five postoperative days. The cognitive function and mood state were preoperatively tested with a set of five neurocognitive tests and two mood inventories and at the seventh postoperative day. The Reliable Change Index modified for practice (RCIp) using data from normative controls was applied to determine the significant decline in test performance.ResultsThe LIR (n = 20) and HIR (n = 22) groups differed significantly in the PCT (p < 0.001) but not in the CRP time courses. The incidence of POCD at the first postoperative week was 35.7% in the cohort. The LIR and HIR groups did not vary in the RCIp Z scores of neurocognitive tests and frequencies of POCD (7 vs 8 cases, respectively, p > 0.05). Additionally, there was no difference in the mood states, anxiety levels and perioperative parameters known to influence the development of POCD.ConclusionsIn this study, the magnitude of the non-infective inflammatory response generated by on-pump cardiac surgery did not influence the development of POCD in the early postoperative period in elderly patients.

【 授权许可】

CC BY   
© The Author(s). 2017