Anaesthesia and Critical Care, Academic Unit of Injury, Inflammation and Recovery Science, University of Nottingham, Nottingham, UK.
Anaesthesia and Critical Care, Academic Unit of Injury, Inflammation and Recovery Science, University of Nottingham, Nottingham, UK.
Br J Anaesth. 2021 Sep;127(3):424-434. doi: 10.1016/j.bja.2021.04.033. Epub 2021 Jul 1.
Postoperative delirium has eluded attempts to define its complex aetiology and describe specific risk factors. The role of neuroinflammation as a risk factor, determined by measuring blood levels of preoperative 'innate' inflammatory mediator levels, has been investigated. However, results have been conflicting. We conducted a systematic review and meta-analysis of the evidence on associations between preoperative blood levels of inflammatory mediators and postoperative delirium in the older person. Influence of type of surgery was also assessed.
Original, low risk of bias studies, published in peer-reviewed journals, which fulfilled the eligibility criteria were included. Seventeen articles fulfilled study criteria. Data extraction, synthesis, and risk of bias analysis were guided by Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) and quality in prognostic studies guidelines. Meta-analyses used a random-effects model. Inflammatory mediators included C-reactive protein, interleukin-6, -8, and -10, tumour necrosis factor-α, insulin-like growth factor-1, cortisol, and neopterin. Surgical groups were cardiac, noncardiac, and hip fracture.
Higher preoperative interleukin-6 was associated with postoperative delirium with a standardised mean difference (95% confidence interval) of 0.33 (0.11-0.56) and P=0.003. Higher neopterin was also associated with postoperative delirium.
The association of preoperative blood levels of inflammatory mediators with postoperative delirium may be influenced by the type of surgery and the specific mediator. The potential modulating effect of type of surgery, intrinsic brain vulnerability, and the complex interactions between inflammatory mediators and binding proteins will need to be considered in future studies.
CRD42019159471 (PROSPERO).
术后谵妄的复杂病因学和特定风险因素一直难以确定。已经研究了神经炎症作为风险因素的作用，通过测量术前“固有”炎症介质水平的血液水平来确定。然而，结果却存在矛盾。我们对术前血液炎症介质水平与老年人术后谵妄之间的相关性进行了系统评价和荟萃分析。还评估了手术类型的影响。
纳入了发表在同行评议期刊上的原始、低偏倚风险的研究，这些研究符合入选标准。有 17 篇文章符合研究标准。数据提取、综合和偏倚风险分析均由系统评价和荟萃分析的首选报告项目（PRISMA）和预后研究质量指南指导。荟萃分析采用随机效应模型。炎症介质包括 C 反应蛋白、白细胞介素-6、-8 和 -10、肿瘤坏死因子-α、胰岛素样生长因子-1、皮质醇和新蝶呤。手术组包括心脏、非心脏和髋部骨折。
较高的术前白细胞介素-6 与术后谵妄相关，标准化均数差（95%置信区间）为 0.33（0.11-0.56），P=0.003。较高的新蝶呤也与术后谵妄相关。
术前血液炎症介质水平与术后谵妄的相关性可能受手术类型和特定介质的影响。未来的研究需要考虑手术类型、内在大脑脆弱性以及炎症介质和结合蛋白之间的复杂相互作用的潜在调节作用。
CRD42019159471（PROSPERO）。
