Influence of the postoperative inflammatory response on cognitive decline in elderly patients undergoing on-pump cardiac surgery: A controlled, prospective observational study

Endre Nemeth, Katalin Vig, Kristof Racz, Kinga B. Koritsanszky, Klara I. Ronkay, Fumiko P. Hamvas, Csaba Borbély, Ajandek Eory, B. Merkely, J. Gál

Research output: Contribution to journalArticle

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Abstract

Background: The role of non-infective inflammatory response (IR) in the aetiology of postoperative cognitive dysfunction (POCD) is still controversial. The aim of this controlled, prospective observational study was to assess the possible relationship between the grade of IR, defined by procalcitonin (PCT) changes, and development of POCD related to cardiac surgery. Methods: Forty-two patients, who were ≥ 60 years of age and scheduled for elective cardiac surgery, were separated into the low inflammatory (LIR) and high inflammatory (HIR) response groups based on their PCT levels measured on the first postoperative day. A matched normative control group of 32 subjects was recruited from primary care practice. The PCT and C-reactive protein (CRP) levels were monitored daily during the first five postoperative days. The cognitive function and mood state were preoperatively tested with a set of five neurocognitive tests and two mood inventories and at the seventh postoperative day. The Reliable Change Index modified for practice (RCIp) using data from normative controls was applied to determine the significant decline in test performance. Results: The LIR (n = 20) and HIR (n = 22) groups differed significantly in the PCT (p < 0.001) but not in the CRP time courses. The incidence of POCD at the first postoperative week was 35.7% in the cohort. The LIR and HIR groups did not vary in the RCIp Z scores of neurocognitive tests and frequencies of POCD (7 vs 8 cases, respectively, p > 0.05). Additionally, there was no difference in the mood states, anxiety levels and perioperative parameters known to influence the development of POCD. Conclusions: In this study, the magnitude of the non-infective inflammatory response generated by on-pump cardiac surgery did not influence the development of POCD in the early postoperative period in elderly patients.

Original languageEnglish
Article number113
JournalBMC Anesthesiology
Volume17
Issue number1
DOIs
Publication statusPublished - Aug 29 2017

Fingerprint

Calcitonin
Thoracic Surgery
Observational Studies
Prospective Studies
Postoperative Period
C-Reactive Protein
Cognition
Primary Health Care
Anxiety
Equipment and Supplies
Control Groups
Cognitive Dysfunction

Keywords

  • C-reactive protein
  • Cardiac surgery
  • Cardiopulmonary bypass
  • Postoperative cognitive dysfunction
  • Procalcitonin
  • Reliable Change Index

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Influence of the postoperative inflammatory response on cognitive decline in elderly patients undergoing on-pump cardiac surgery : A controlled, prospective observational study. / Nemeth, Endre; Vig, Katalin; Racz, Kristof; Koritsanszky, Kinga B.; Ronkay, Klara I.; Hamvas, Fumiko P.; Borbély, Csaba; Eory, Ajandek; Merkely, B.; Gál, J.

In: BMC Anesthesiology, Vol. 17, No. 1, 113, 29.08.2017.

Research output: Contribution to journalArticle

Nemeth, Endre ; Vig, Katalin ; Racz, Kristof ; Koritsanszky, Kinga B. ; Ronkay, Klara I. ; Hamvas, Fumiko P. ; Borbély, Csaba ; Eory, Ajandek ; Merkely, B. ; Gál, J. / Influence of the postoperative inflammatory response on cognitive decline in elderly patients undergoing on-pump cardiac surgery : A controlled, prospective observational study. In: BMC Anesthesiology. 2017 ; Vol. 17, No. 1.
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abstract = "Background: The role of non-infective inflammatory response (IR) in the aetiology of postoperative cognitive dysfunction (POCD) is still controversial. The aim of this controlled, prospective observational study was to assess the possible relationship between the grade of IR, defined by procalcitonin (PCT) changes, and development of POCD related to cardiac surgery. Methods: Forty-two patients, who were ≥ 60 years of age and scheduled for elective cardiac surgery, were separated into the low inflammatory (LIR) and high inflammatory (HIR) response groups based on their PCT levels measured on the first postoperative day. A matched normative control group of 32 subjects was recruited from primary care practice. The PCT and C-reactive protein (CRP) levels were monitored daily during the first five postoperative days. The cognitive function and mood state were preoperatively tested with a set of five neurocognitive tests and two mood inventories and at the seventh postoperative day. The Reliable Change Index modified for practice (RCIp) using data from normative controls was applied to determine the significant decline in test performance. Results: The LIR (n = 20) and HIR (n = 22) groups differed significantly in the PCT (p < 0.001) but not in the CRP time courses. The incidence of POCD at the first postoperative week was 35.7{\%} in the cohort. The LIR and HIR groups did not vary in the RCIp Z scores of neurocognitive tests and frequencies of POCD (7 vs 8 cases, respectively, p > 0.05). Additionally, there was no difference in the mood states, anxiety levels and perioperative parameters known to influence the development of POCD. Conclusions: In this study, the magnitude of the non-infective inflammatory response generated by on-pump cardiac surgery did not influence the development of POCD in the early postoperative period in elderly patients.",
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AU - Nemeth, Endre

AU - Vig, Katalin

AU - Racz, Kristof

AU - Koritsanszky, Kinga B.

AU - Ronkay, Klara I.

AU - Hamvas, Fumiko P.

AU - Borbély, Csaba

AU - Eory, Ajandek

AU - Merkely, B.

AU - Gál, J.

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N2 - Background: The role of non-infective inflammatory response (IR) in the aetiology of postoperative cognitive dysfunction (POCD) is still controversial. The aim of this controlled, prospective observational study was to assess the possible relationship between the grade of IR, defined by procalcitonin (PCT) changes, and development of POCD related to cardiac surgery. Methods: Forty-two patients, who were ≥ 60 years of age and scheduled for elective cardiac surgery, were separated into the low inflammatory (LIR) and high inflammatory (HIR) response groups based on their PCT levels measured on the first postoperative day. A matched normative control group of 32 subjects was recruited from primary care practice. The PCT and C-reactive protein (CRP) levels were monitored daily during the first five postoperative days. The cognitive function and mood state were preoperatively tested with a set of five neurocognitive tests and two mood inventories and at the seventh postoperative day. The Reliable Change Index modified for practice (RCIp) using data from normative controls was applied to determine the significant decline in test performance. Results: The LIR (n = 20) and HIR (n = 22) groups differed significantly in the PCT (p < 0.001) but not in the CRP time courses. The incidence of POCD at the first postoperative week was 35.7% in the cohort. The LIR and HIR groups did not vary in the RCIp Z scores of neurocognitive tests and frequencies of POCD (7 vs 8 cases, respectively, p > 0.05). Additionally, there was no difference in the mood states, anxiety levels and perioperative parameters known to influence the development of POCD. Conclusions: In this study, the magnitude of the non-infective inflammatory response generated by on-pump cardiac surgery did not influence the development of POCD in the early postoperative period in elderly patients.

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KW - Procalcitonin

KW - Reliable Change Index

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