O-177 - THE PREDICTING ROLE OF INFLAMMATORY BIOCHEMICAL MARKERS IN POST-OPERATIVE DELIRIUM AFTER VASCULAR SURGERY PROCEDURES

TOPIC:
Other
AUTHORS:
Pasqui E. (Vascular Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, ~ Siena ~ Italy) , De Donato G. (Vascular Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, ~ Siena ~ Italy) , Brancaccio B. (Vascular Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, ~ Siena ~ Italy) , Casilli G. (Vascular Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, ~ Siena ~ Italy) , Ferrante G. (Vascular Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, ~ Siena ~ Italy) , Cappelli A. (Vascular Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, ~ Siena ~ Italy) , Palasciano G. (Vascular Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, ~ Siena ~ Italy)
Introduction:
Postoperative Delirium (POD) is a common complication, especially in elderly patients who underwent vascular surgery procedures. The aim of this study was to evaluate the relation of inflammatory biochemical markers as Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR) and Systemic Inflammation Index (SII) with POD occurrence after vascular surgery procedure.
Methods:
This was a single-center, retrospective, observational study. We analyzed the perioperative data of patients who had undergone elective vascular surgery procedures. POD-positive (POD-pos) group and POD-negative (POD-neg) group were defined with respect to the occurrence of delirium after procedure or not. ROC curves were performed to find the appropriate cut-off values of NLR, PLR and SII. Multivariate analysis was used to identify the independent predictors for POD.
Results:
A total of 646 patients were enrolled. Mean age was 76.2±9.8, 442 (68.4%) were male. Seventy-three patients (11.3%) developed POD during hospitalization. Fifty had hyperactive POD that necessitated dedicated drugs administration, of them 17 also needed physical contention. Descriptive analysis between the two study groups revealed that patients included in POD-pos group were likely older, had a history of cardiac disease (heart failure and coronary artery disease), chronic renal failure and dialysis and had a pre-existing psychiatric disease. In addition, they were more likely to have a previous hospitalization within 1 month. In terms of vascular procedures performed, POD occurred more frequently in patients who underwent aortic open repair, endovascular revascularization procedures for chronic-limb-threatening-ischemia, and major amputation. Mean hospital stay was significantly increased in POD-pos group (6.1±5.4 vs 3.2±2.8 days, p=0.0001). In-hospital death and in-hospital MACE were not increased in POD-pos group while in-hospital reinterventions were more frequently performed in POD-pos group respect to POD-neg group (8.2% vs 3.8%, p=0.11). Blood values analysis reported significant differences. Hb (11.5±2.9 vs 13.1±2.1, p=0.0001), WBC (9.56±3.88 vs 8.1±2.96, p=0.0001), neutrophil subpopulation (7.1±3.67 vs 5.4±2.5, p=0.0001), lymphocyte subpopulation (1.52±0.72 vs 1.8±0.86, p=0.0079), NLR (5.99±5.2 vs 3.77±3.2, p=0.0001), PLR (199.4±149.6 vs 158.5±103.8, p=0.0028), SII (1674.9±1067.7 vs 945.6±745.3, p=0.0001), Creatinine (1.46±0.7 vs 1.21±0.9, p=0.022) and C-protein Reactive (2.42±1.2 vs 0.77±2.74, p=0.0001) were statistically different between POD-pos and POD-neg groups, respectively. ROC curves identified cut-off values for NLR>3.57, PLR>139.2 and SII>676.4. Multivariate analysis revealed that age, Renal Failure, peripheral revascularization procedures, major amputation, general anesthesia, hospitalization in the previous month, NLR>3.57 NLR>3.57 (HR 1.612 CI [0.853-3.45]) and SII>676.4 (HR 2.128 [1.14-5.83]) were independent risk factors for POD.
Conclusion:
POD represents a common complication of vascular surgery patients. Our study demonstrated that NLR, PLR and SII are reliable and readily available laboratory predictors of POD in vascular surgery that could help in POD risk-stratification.
References:
1-Noah AM, Almghairbi D, Evley R, Moppett IK. Preoperative inflammatory mediators and postoperative delirium: systematic review and meta-analysis. Br J Anaesth. 2021;127(3):424-434. 2- He R, Wang F, Shen H, Zeng Y, LijuanZhang. Association between increased neutrophil-to-lymphocyte ratio and postoperative delirium in elderly patients with total hip arthroplasty for hip fracture. BMC Psychiatry. 2020;20(1):496.
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