The Predictive Role of Inflammatory Biochemical Markers in Post-Operative Delirium After Vascular Surgery Procedures

Figures & data

Table 1 Baseline Characteristics of Study Population

Variables	Total Population	POD-Pos Group	POD-Neg Group	p value
	N=646	N=73	N=573
Age	76.2±9.8	81.9±7.2	75.4±9.8	<0.01
Male	442 (68.4%)	51 (69.9%)	391 (68.2%)	0.89
Hypertension	540 (83.6%)	64 (87.7%)	476 (83.1%)	0.43
CAD	184 (28.4%)	31 (42.5%)	153 (26.7%)	<0.01
Heart failure	71 (11%)	16 (21.9%)	55 (9.6%)	<0.01
Atrial fibrillation	92 (14.2%)	13 (17.8%)	51 (13.8%)	0.04
History of cerebrovascular disease	111 (17.2%)	18 (24.6%)	93 (16.2%)	0.09
Dyslipidaemia	408 (63.2%)	38 (52.1%)	370 (64.6%)	<0.05
Smoke (active or past)	378 (58.5%)	36 (49.3%)	342 (52.9%)	0.15
Diabetes Mellitus	230 (35.6%)	29 (39.7%)	201 (35.1%)	0.43
COPD	124 (19.2%)	18 (24.7%)	106 (18.5%)	0.27
Chronic renal disease (non-dialysis)	179 (27.7%)	34 (46.6%)	145 (25.3%)	<0.01
Dialysis	12 (1.8%)	4 (5.5%)	8 (1.39%)	<0.05
Malignancies	128 (19.8%)	17 (23.3%)	111 (19.3%)	0.43
Psychiatric disease	71 (11%)	16 (21.9%)	55 (9.6%)	<0.01
Liver disease	17 (2.6%)	3 (4.1%)	14 (2.45)	0.42
Drugs
Antiplatelet	396 (61.3%)	36 (49.3%)	360 (62.8%)	0.03
Dual antiplatelet	83 (12.8%)	10 (13.7%)	73 (12.7%)	0.85
Statin	372 (57.6%)	39 (53.4%)	333 (58.1%)	0.45
Anticoagulant	136 (21.1%)	24 (32.9%)	112 (19.5%)	0.01
Antipsychotic	89 (13.8%)	21 (28.8%)	68 (11.8%)	<0.01
Other Hospitalization within 1 month	58 (9%)	16 (21.9%)	42 (7.3%)	<0.01
Pre-operative exams
Hb (g/dl)	12.9±2.3	11.5±2.9	13.1±2.1	<0.01
WBC	8.25±3.1	9.56±3.88	8.1±2.96	<0.01
Neutrophil	5.6±2.7	7.1±3.67	5.4±2.5	<0.01
Lymphocyte	1.77±0.85	1.52±0.72	1.8±0.86	<0.01
Platelets	240.6±87.5	251.9±101.5	239.2±85.5	0.24
NLR	4.03±3.7	5.99±5.2	3.77±3.2	<0.01
PLR	163.17±110.6	199.4±149.6	158.5±103.8	<0.01
SII	1018.73±456.5	1674.9±1067.7	945.6±745.3	<0.01
Creatinine (mg/dl)	1.24±0.5	1.46±0.7	1.21±0.9	0.02
C-reactive protein	0.91±2.2	2.42±1.2	0.77±2.74	<0.01

Note: Bold text indicates p value <0.05.

Abbreviations: CAD, coronary artery disease; COPD, chronic obstructive pulmonary disease; Hb, hemoglobin; WBC, white blood cell; NLR, neutrophil-to-lymphocyte ratio; PLR, platelet-to-lymphocyte ratio; SII, Systemic Inflammatory Index.

Table 2 Procedural Characteristics and In-Hospital Outcomes

Variables	Total Population N=646	POD-Pos Group	POD-Neg Group	p value
		N=73	N=573
Carotid Artery Revascularization
CAS	100 (15.5%)	8 (10.9%)	92 (16.1%)	0.32
CEA	50 (7.7%)	2 (2.7%)	48 (8.4%)	0.14
AAA Repair
Open	14 (2.2%)	5 (6.8%)	9 (1.6%)	0.01
EVAR	109 (16.8%)	7 (9.6%)	102 (17.8%)	0.09
PAD Revascularization Procedure
Endovascular	255 (39.5%)	39 (53.4%)	216 (37.2%)	0.01
Open surgery	40 (6.2%)	7 (9.6%)	33 (5.8%)	0.19
Hybrid	34 (5.3%)	5 (6.8%)	29 (5.1%)	0.73
Major amputation	44 (6.8%)	13 (17.8%)	31 (5.4%)	<0.05
Anesthesia
Local/loco-regional	602 (93.2%)	57 (78.1%)	545 (95.1%)	<0.05
General	44 (6.8%)	16 (21.9%)	28 (4.9%)	<0.05

Note: Bold text indicates p value <0.05.

Abbreviations: CAS, carotid artery stenting; CEA, carotid endarterectomy; AAA, abdominal aortic aneurysm; PAD, peripheral artery disease.

Table 3 Secondary Outcomes Between POD-Pos and POD-Neg Groups

Variables	Total Population N=646	POD-Pos Group	POD-Neg Group	p value
		N=73	N=573
Mean hospital stay (days)	3.6±3.2	6.1±5.4	3.2±2.8	<0.05
ICU needing	14 (2.2%)	2 (2.7%)	12 (2.1%)	0.66
Mean procedural time (min)	90.7±56.8	97.7±65	90.2±56	0.29
Use of contrast medium during procedure	521 (80.6%)	53 (72.6%)	468 (81.7%)	0.08
In-hospital reintervention	28 (4.3%)	6 (8.2%)	22 (3.8%)	0.11
In-hospital death	7 (1.1%)	2 (2.7%)	5 (6.8%)	0.18
In-hospital MACE	6 (0.9%)	1 (1.3%)	5 (6.8%)	0.51

Note: Bold text indicates p value <0.05.

Abbreviations: ICU, Intensive Care Unit; MACE, major cardiovascular events.

Figure 1 Biochemical markers differences between POD-pos and POD-neg groups. Asterisks indicate high significant difference between the two groups (p=0.0001).

Figure 2 Receiver operating characteristic curves of the three biochemical markers (NLR, PLR and SII) evaluated.

Table 4 Results from Multivariate Analysis: Effect of Various Variables Extrapolated from Univariate Analysis on POD Incidence

Variables	Hazard Ratio (95% CI)	p value
Age	1.81 (1.73–2.92)	0.03
CKD	2.32 (1.73–3.22)	0.04
History of psychiatric disease	1.94 (1.56–3.62)	0.04
Hospitalization in the previous month	1.75 (1.45–2.47)	0.03
PAD revascularization procedure	1.43 (1.27–2.78)	0.04
Major amputation	1.65 (1.45–3.12)	0.03
General anesthesia	1.94 (1.49–3.34)	0.001
NLR > 3.57	1.76 (1.23–2.61)	0.04
SII > 676.4	1.97 (1.67–3.12)	0.03
Hb < 7	2.12 (1.57–3.56)	0.04

Abbreviations: CKD, chronic kidney disease; PAD, peripheral artery disease; NLR, neutrophil-to-lymphocyte ratio; SII, Systemic Inflammation Index; Hb, hemoglobin.