Zhang Lin, Li Baoquan, Bai Yujiang, Liu Xiaoshuang, Chai Xin
Orthopedic Surgery, The Second Affiliated Hospital of Qiqihar Medical University, Qiqihar, China.
Orthopedic Surgery, The Third Affiliated Hospital of Qiqihar Medical University, Qiqihar, China.
Front Surg. 2022 Aug 16;9:814345. doi: 10.3389/fsurg.2022.814345. eCollection 2022.
This study aimed to investigate the relationship between serum C-reactive protein (CRP)/Albumin ratio (CAR) and postoperative delirium (POD) in patients older than 60 years following total knee arthroplasty (TKA).
From January 2019 to January 2021, 268 patients were recruited in this prospective observational investigation. Patients with serum CRP, Alb, CAR, delirious status and delirious score were assessed. The effect of CRP, Alb, CAR on predicting delirium was assessed with the area under the receiver operating characteristic (ROC) curve (AUC).
The study found that higher CRP level ( < 0.001), low Alb level ( < 0.001), and higher CAR ( < 0.001) were independently associated with POD. The AUC of CAR for POD was 0.782, with the cut-off value of 0.117, a sensitivity of 83.3% and a specificity of 65.9% respectively ( < 0.001), suggesting that CAR had moderate efficacy on predicting POD occurrence than CRP (AUC: 0.761) and Alb (AUC: 0.300). The results also showed that age, ASA and the operation time was an independent predictor for patients with POD.
Our findings demonstrated CAR may be an effective biomarker to predict postoperative delirium in patients over 60 years of age with TKA, which provides potential recommendations for early intervention in delirium care.
本研究旨在调查全膝关节置换术（TKA）后60岁以上患者血清C反应蛋白（CRP）/白蛋白比值（CAR）与术后谵妄（POD）之间的关系。
2019年1月至2021年1月，本前瞻性观察性研究招募了268例患者。评估患者的血清CRP、Alb、CAR、谵妄状态和谵妄评分。采用受试者操作特征（ROC）曲线下面积（AUC）评估CRP、Alb、CAR对谵妄的预测作用。
研究发现，较高的CRP水平（<0.001）、较低的Alb水平（<0.001）和较高的CAR（<0.001）与POD独立相关。CAR预测POD的AUC为0.782，临界值为0.117，敏感性分别为83.3%，特异性为65.9%（<0.001），表明CAR在预测POD发生方面比CRP（AUC：0.761）和Alb（AUC：0.300）具有中等疗效。结果还显示，年龄、美国麻醉医师协会（ASA）分级和手术时间是POD患者的独立预测因素。
我们的研究结果表明，CAR可能是预测60岁以上TKA患者术后谵妄的有效生物标志物，这为谵妄护理的早期干预提供了潜在建议。
