Postoperative Cognitive Dysfunction (POCD) and Inflammatory Markers in Elderly Patients
Détails
ID Serval
serval:BIB_9D974DF8DEBD
Type
Actes de conférence (partie): contribution originale à la littérature scientifique, publiée à l'occasion de conférences scientifiques, dans un ouvrage de compte-rendu (proceedings), ou dans l'édition spéciale d'un journal reconnu (conference proceedings).
Sous-type
Abstract (résumé de présentation): article court qui reprend les éléments essentiels présentés à l'occasion d'une conférence scientifique dans un poster ou lors d'une intervention orale.
Collection
Publications
Institution
Titre
Postoperative Cognitive Dysfunction (POCD) and Inflammatory Markers in Elderly Patients
Titre de la conférence
Annual meeting of the Swiss Society of Anaesthesiology and Resuscitation
Adresse
Lausanne, Switzerland, November 4-6, 2010
ISBN
1424-7860
Statut éditorial
Publié
Date de publication
2010
Peer-reviewed
Oui
Volume
140
Série
Swiss Medical Weekly
Pages
8
Langue
anglais
Notes
Meeting Abstract
Résumé
Introduction: Particularly in elderly patients, the brain responds to a systemic inflammatory response with an increased production of inflammatory mediators. This has hypothetically been linked to the development of postoperative cognitive dysfunction (POCD).
Methods: We investigated 31 patients aged >65 yrs undergoing elective major surgery under standardized general anaesthesia (thiopental, sevoflurane, fentanyl, atracurium). Cognitive function was measured preoperatively and 7 days postoperatively using the extended version of the Consortium to Establish a Registry for Alzheimer's Disease - Neuropsychological Assessment Battery (CERAD-NAB, validated German version) for which we developed a diagnostic cut-off in healthy elderly volunteers. Systemic C-reactive protein (CRP) and interleukin 6 (IL-6) were measured preoperatively, 2 days postoperatively, and 7 days postoperatively. Values for CRP, IL-6, operative characteristics and hospital length of stay in patients with POCD and without POCD were compared using the Mann- Whitney U test and are shown as median [range]. Results: Fourteen patients (45%) developed POCD. Values for CRP were not statistically different in patients with POCD and without POCD but tended to be higher in patients with POCD 2 days postoperatively. Patients with POCD had significantly higher IL-6 values on postoperative days 2 and 7 (table 1). These patients also had a significantly longer duration of anaesthesia (305 [195-620] vs.190 [150-560] min, p = 0.034), larger intraoperative blood loss (425 [0-1600] vs. 100 [0-1500] ml, p = 0.018) and longer hospital stays (15 [8-45] vs. 8 [4-40] days, p = 0.008).
Table 1 POCD (n = 14) No POCD (n = 17) p value
CRP (mg/dl) preop. 4.0 [1.0-245] 4.2 [0.3-36.2] 0.6
2 days postop. 223 [20-318] 98 [4.5-384] 0.07
7 days postop. 58 [15-147] 44 [11-148] 0.2
IL-6 (U/ml) preop. 2[2-28.1] 2 [2-7.3] 0.8
2 days postop. 56 [17-315] 20 [2-123] 0.009
7 days postop. 9[2-77] 4 [2-16] 0.03
Interpretation: In this small group of patients, high IL-6 values postoperatively were associated with POCD supporting a role for systemic inflammation in the development of POCD. In patients with POCD, duration of anaesthesia was significantly longer, and intraoperative blood losses were larger. These risk factors will need to be confirmed in a larger group of patients. The difference in length of stay may be indicative of postoperative complications, which have been linked to POCD earlier.
Methods: We investigated 31 patients aged >65 yrs undergoing elective major surgery under standardized general anaesthesia (thiopental, sevoflurane, fentanyl, atracurium). Cognitive function was measured preoperatively and 7 days postoperatively using the extended version of the Consortium to Establish a Registry for Alzheimer's Disease - Neuropsychological Assessment Battery (CERAD-NAB, validated German version) for which we developed a diagnostic cut-off in healthy elderly volunteers. Systemic C-reactive protein (CRP) and interleukin 6 (IL-6) were measured preoperatively, 2 days postoperatively, and 7 days postoperatively. Values for CRP, IL-6, operative characteristics and hospital length of stay in patients with POCD and without POCD were compared using the Mann- Whitney U test and are shown as median [range]. Results: Fourteen patients (45%) developed POCD. Values for CRP were not statistically different in patients with POCD and without POCD but tended to be higher in patients with POCD 2 days postoperatively. Patients with POCD had significantly higher IL-6 values on postoperative days 2 and 7 (table 1). These patients also had a significantly longer duration of anaesthesia (305 [195-620] vs.190 [150-560] min, p = 0.034), larger intraoperative blood loss (425 [0-1600] vs. 100 [0-1500] ml, p = 0.018) and longer hospital stays (15 [8-45] vs. 8 [4-40] days, p = 0.008).
Table 1 POCD (n = 14) No POCD (n = 17) p value
CRP (mg/dl) preop. 4.0 [1.0-245] 4.2 [0.3-36.2] 0.6
2 days postop. 223 [20-318] 98 [4.5-384] 0.07
7 days postop. 58 [15-147] 44 [11-148] 0.2
IL-6 (U/ml) preop. 2[2-28.1] 2 [2-7.3] 0.8
2 days postop. 56 [17-315] 20 [2-123] 0.009
7 days postop. 9[2-77] 4 [2-16] 0.03
Interpretation: In this small group of patients, high IL-6 values postoperatively were associated with POCD supporting a role for systemic inflammation in the development of POCD. In patients with POCD, duration of anaesthesia was significantly longer, and intraoperative blood losses were larger. These risk factors will need to be confirmed in a larger group of patients. The difference in length of stay may be indicative of postoperative complications, which have been linked to POCD earlier.
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Création de la notice
17/01/2011 17:54
Dernière modification de la notice
20/08/2019 16:03
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