The association of C-Reactive Protein with Delirium Severity: An analysis of a prospective cohort study
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Background
Postoperative delirium (POD) is common in elderly patients and is linked to poor recovery and greater mortality. Inflammation has been implicated in its pathophysiology and recent meta-analysis suggests steroids may have utility in preventing POD. This study aimed to evaluate whether C-reactive protein (CRP) predicts severity (or incidence) of POD. Our secondary outcome analysed whether anti-emetic doses of dexamethasone meaningfully altered inflammatory responses in this age group.
Methods
Patients (n=122) ≥60 years of age undergoing major surgery were recruited to a prospective cohort study in which CRP was measured preoperatively and on postoperative day 1. Delirium was assessed using the 3-minute diagnostic Confusion Assessment Method (3D-CAM) twice daily on days 1–3. CRP was analysed against the outcomes of incidence (positive overall 3D-CAM) and peak severity (maximum 3D-CAM score) of POD.
Results
POD occurred in 20/122 (16.4%); mean peak severity 2.1 (SD 2.1). Postoperative CRP was associated with the primary outcome, POD severity (predicted probability 94.7%) as well as incidence (predicted probability 99.9%). Dexamethasone reduced CRP by 41% (95% CrI 8-62%, predicted probability 99.1%).
Conclusion
Routine postoperative CRP was independently associated with POD incidence and severity. Dexamethasone, at anti-emetic doses, was associated with a substantial reduction in CRP levels, supporting trials focussed on modulating inflammation to prevent delirium.
