Kunkel David, Parker Margaret, Casey Cameron, Krause Bryan, Taylor Jennifer, Pearce Robert A, Lennertz Richard, Sanders Robert D
Department of Anesthesiology, University of Wisconsin, Madison, WI, USA.
Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
BJA Open. 2022 Apr 14;2:100006. doi: 10.1016/j.bjao.2022.100006. eCollection 2022 Jun.
Perioperative inflammation is associated with perioperative complications, including delirium, that are associated with a reduced number of postoperative days alive and at home at 90 days (DAH90). We tested whether inflammation was associated with DAH90 even when adjusting for perioperative factors, and whether inflammation independently was associated with DAH90 when adjusting for delirium.
We conducted a prospective cohort study of major, non-intracranial surgical patients who were older than 65 yr (=134). We measured postoperative delirium incidence and severity, and changes in interleukin (IL)-8 and IL-10 in blood plasma. Our primary outcome, DAH90, was analysed using quantile regression.
Before adjusting for delirium, a postoperative day 1 increased IL-8 was associated with fewer DAH90 at the 0.75 quantile (β=-0.082; 95% confidence interval [CI], -0.19 to -0.006) after adjusting for demographic (age and sex) and perioperative factors (cardiovascular surgery, National Surgical Quality Improvement Program risk of death, and operative time). IL-10 was similarly associated with DAH90 at the 0.5 (β=-0.026; 95% CI, -0.19 to -0.001) and 0.75 (β= -0.035; 95% CI, -0.07 to -0.006) quantiles. Neither cytokine was significantly associated with DAH90 once delirium and baseline Trail Making Test B were added to the models.
Perioperative inflammation predicts DAH90, but when delirium is added to the model inflammation loses significance as a predictor, whereas delirium is significant. Targeting perioperative inflammation may reduce delirium and moderate hospital readmission and mortality.
NCT03124303.
围手术期炎症与围手术期并发症相关，包括谵妄，而谵妄与术后90天存活且在家的天数（DAH90）减少有关。我们测试了即使在调整围手术期因素后炎症是否仍与DAH90相关，以及在调整谵妄后炎症是否独立与DAH90相关。
我们对134例年龄大于65岁的非颅内大手术患者进行了一项前瞻性队列研究。我们测量了术后谵妄的发生率和严重程度，以及血浆中白细胞介素（IL）-8和IL-10的变化。我们使用分位数回归分析了主要结局指标DAH90。
在调整谵妄之前，术后第1天IL-8升高与在第0.75分位数时较少的DAH90相关（β=-0.082；95%置信区间[CI]，-0.19至-0.006），这是在调整了人口统计学因素（年龄和性别）和围手术期因素（心血管手术、国家外科质量改进计划死亡风险和手术时间）之后。IL-10在第0.5（β=-0.026；95%CI，-0.19至-0.001）和第0.75（β=-0.035；95%CI，-0.07至-0.006）分位数时同样与DAH90相关。一旦将谵妄和基线连线测验B加入模型，这两种细胞因子均与DAH90无显著关联。
围手术期炎症可预测DAH90，但当将谵妄加入模型时，炎症作为预测因子失去意义，而谵妄具有显著性。针对围手术期炎症可能会减少谵妄，并降低医院再入院率和死亡率。
NCT03124303。
