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Observational Study
. 2017 Aug 29;17(1):113.
doi: 10.1186/s12871-017-0408-1.

Influence of the Postoperative Inflammatory Response on Cognitive Decline in Elderly Patients Undergoing On-Pump Cardiac Surgery: A Controlled, Prospective Observational Study

Free PMC article
Observational Study

Influence of the Postoperative Inflammatory Response on Cognitive Decline in Elderly Patients Undergoing On-Pump Cardiac Surgery: A Controlled, Prospective Observational Study

Endre Nemeth et al. BMC Anesthesiol. .
Free PMC article


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.

Keywords: C-reactive protein; Cardiac surgery; Cardiopulmonary bypass; Postoperative cognitive dysfunction; Procalcitonin; Reliable Change Index.

Conflict of interest statement

Ethics approval and consent to participate

This study was conducted in accordance with the Declaration of Helsinki and approved by the Regional and Institutional Committee of Science and Research Ethics, Semmelweis University, Budapest, Hungary. Number of ethical approval: No: 99/2012. Date of approval: 13.09.2012. Written informed consent was obtained from all participants.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.


Fig. 1
Fig. 1
Changes in the procalcitonin (a), C-reactive protein (b) and white blood cell count (c) levels during the postoperative period. A continuous line demonstrates low inflammatory response (LIR) and a dotted line shows the high inflammatory response (HIR) group. Spots and error bars represent the medians and 95% confidence intervals. Significant differences between the LIR and HIR groups are demonstrated with asterisks: *** p < 0.001, Mann-Whitney U test
Fig. 2
Fig. 2
RCIp Z scores of neurocognitive tests. Z score means are demonstrated with a blank bar in the low inflammatory response group and striped bar in the high inflammatory response group. Error bars represent the standard error of the mean. The limit of the significant decline in performance is indicated by a continuous line at RCIp Z score of −1.96. None of the neurocognitive tests showed a significant decline at the group level. The RCIp Z scores were similar in the two inflammatory response groups, except the Stroop word task, based on the Mann-Whitney U test. Significant differences between the LIR and HIR groups are demonstrated with asterisks: * p < 0.05. MMSE = Mini Mental State Examination; TMA = Trail Making Test A; TMB = Trail Making Test B; DS = Digit Symbol test; Stroop W = Stroop word task; Stroop C = Stroop colour task; and Stroop CW = Stroop colour-word task

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