Linear association between high-sensitivity C-reactive protein and postoperative delirium after general anesthesia: A cross-sectional study

Xiao Qin ¹ Junming Ren ^2* Chunping Xing ^1* Lijiao Chen ^3* Renjie Wang ⁴ Shouyuan Tian ^5*

• ¹ Department of Anesthesiology, General Hospital of Tisco, Sixth Hospital of Shanxi Medical University, Taiyuan, China
• ² Department of Anesthesiology, Shanxi Provincial People's Hospital, Taiyuan, China
• ³ Department of Anesthesiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
• ⁴ Department of Urology, General Hospital of Tisco, Sixth Hospital of Shanxi Medical University, Taiyuan, China
• ⁵ Shanxi Province Cancer Hospital, Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences, Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, China

Objective: To investigate the association between high-sensitivity C-reactive protein (Hs-CRP) levels and the risk of postoperative delirium (POD) following general anesthesia.This retrospective cross-sectional study included 644 patients who underwent general anesthesia.Univariate and multivariate logistic regression analyses were performed to evaluate the relationship between Hs-CRP and POD, with subgroup analyses used to assess stratified associations. Receiver operator characteristic (ROC) curve analysis was employed to assess the predictive efficacy of Hs-CRP for POD. Restricted cubic spline (RCS) analysis was conducted to explore the linear relationship between the log-transformed Hs-CRP (Log10Hs-CRP) and POD risk.The total population consisted of 644 individuals with a mean age of 64.02 ± 13.20 years, 506 (78.60%) of whom were male, and 114 patients (17.7%) had POD. Compared to the lower Hs-CRP group, patients in the higher Hs-CRP group exhibited higher age, heart rate, white blood cell count, blood urea nitrogen, creatinine, uric acid, fasting glucose, hemoglobin A1c, fibrinogen, D-dimer, and a higher prevalence of CKD, but lower hemoglobin, high-density lipoprotein cholesterol, albumin and estimated glomerular filtration rate. Additionally, the prevalence of POD was higher in the higher Hs-CRP group (24.7% vs. 9.5%, P < 0.001). Multivariate logistic regression confirmed that elevated Hs-CRP and its forms (Log10Hs-CRP, standardized Hs-CRP, and higher Hs-CRP group) consistently increased the risk of POD across all adjusted models (P < 0.05). Stratified analyses further highlighted significant associations between Hs-CRP and POD in specific subgroups, notably in patients aged ≥ 65 years, female patients, and those with or without hypertension, diabetes, or stroke history, and without chronic kidney disease (P < 0.05). ROC curve analysis demonstrated that Hs-CRP had a significant predictive ability for POD in the overall population (AUC = 0.646), as well as in male (AUC = 0.644) and 字体: (默认)Times New Roman,