Postoperative Cognitive Dysfunction (POCD) and Inflammatory Markers in Elderly Patients

Details

Serval ID
serval:BIB_9D974DF8DEBD
Type
Inproceedings: an article in a conference proceedings.
Publication sub-type
Abstract (Abstract): shot summary in a article that contain essentials elements presented during a scientific conference, lecture or from a poster.
Collection
Publications
Institution
Title
Postoperative Cognitive Dysfunction (POCD) and Inflammatory Markers in Elderly Patients
Title of the conference
Annual meeting of the Swiss Society of Anaesthesiology and Resuscitation
Author(s)
Burkhart C.S., Dell-Kuster S., Monsch A.U., Strebell S.P., Steiner L.A.
Address
Lausanne, Switzerland, November 4-6, 2010
ISBN
1424-7860
Publication state
Published
Issued date
2010
Peer-reviewed
Oui
Volume
140
Series
Swiss Medical Weekly
Pages
8
Language
english
Notes
Meeting Abstract
Abstract
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.
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17/01/2011 16:54
Last modification date
20/08/2019 15:03
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