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Raised preoperative monocyte chemoattractant protein-1 as the independent predictor of delirium after cardiac surgery. A prospective cohort study

Published online by Cambridge University Press:  13 August 2021

J. Kaźmierski ,
P. Miler ,
A. Pawlak ,
H. Jerczyńska ,
E. Frankowska ,
J. Woźniak ,
K. Woźniak ,
A. Brzezińska  and
M. Wilczyński
J. Kaźmierski
Affiliation:
Department Of Old Age Psychiatry And Psychotic Dosorders, Medical University of Lodz, Łódź, Poland
P. Miler*
Affiliation:
Department Of Old Age Psychiatry And Psychotic Dosorders, Medical University of Lodz, Łódź (Łódź-Górna), Poland
A. Pawlak
Affiliation:
Department Of Affective And Psychotic Disorders, Central Clinical Hospital, Łódź, Poland
H. Jerczyńska
Affiliation:
Corelab Central Laboratory Of Medical University Of Lodz, Medical University of Lodz, Lodz, Poland
E. Frankowska
Affiliation:
Department Of Old Age Psychiatry And Psychotic Disorders, Central Clinical Hospital, Lodz, Poland
J. Woźniak
Affiliation:
Department Of Old Age Psychiatry And Psychotic Disorders, Central Clinical Hospital, Lodz, Poland
K. Woźniak
Affiliation:
Department Of Cardiac Surgery, Central Clinical Hospital, Lodz, Poland
A. Brzezińska
Affiliation:
Department Of Old Age Psychiatry And Psychotic Disorders, Central Clinical Hospital, Lodz, Poland
M. Wilczyński
Affiliation:
Department Of Cardiac Surgery, Medical University of Lodz, Lodz, Poland
*
*Corresponding author.

Abstract

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Introduction

Delirium is a frequent and serious complication of cardiac surgery. However, the knowledge regarding pathogenesis of postoperative delirium is limited.

Objectives

To investigate whether increased levels of monocyte chemoattractant protein-1 (MCP-1) and hyper-sensitive C-Reactive Protein (hsCRP) are associated with postoperative delirium in cardiac surgery patients.

Methods

Patients were examined and screened for major depressive disorder (MDD) and cognitive impairment one day preoperatively, using the Mini International Neuropsychiatric Interview and The Mini-Mental State Examination Test. Blood samples were collected pre- and postoperatively for hsCRP and chemokine levels. Following surgical interventions, the Confusion Assessment Method for the Intensive Care Unit and the Memorial Delirium Assessment Scale with the cut-off score 10 were used to diagnose delirium.

Results

Postoperative delirium screening was found positive in 34% (61 of 177) of patients. Both, pre- and postoperative hsCRP, and preoperative MCP-1 levels were associated with postoperative delirium in univariate comparisons; p=0.001; p=0.0004; p < 0.001, respectively. However, according to a multivariate stepwise logistic regression analysis only MCP-1 concentration raised before surgery was independently associated with postoperative delirium, and related to advancing age of participants (Spearman’s Rank Correlation 0.192; p=0.0103). According to ROC analysis, the most optimal cut-off for MCP-1 concentration in predicting the development of delirium was 371.81 ng/ml with sensitivity of 77.0% and specificity of 58.6%.

Conclusions

The present study suggests that raised preoperative MCP-1 concentration is independently associated with delirium after cardiac surgery. Preoperative monitoring of pro-inflammatory markers combined with regular surveillance may be helpful in the prediction and early detection of postoperative delirium in this patient group.

Keywords

deliriumCardiac surgeryInflammationMajor depressive disorders
Type
Abstract
Information
European Psychiatry , Volume 64 , Special Issue S1: Abstracts of the 29th European Congress of Psychiatry , April 2021 , pp. S252
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of the European Psychiatric Association
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