Erythropoietin for the prevention of postoperative neurocognitive disorder in older adult patients undergoing total joint arthroplasty: a randomized controlled study.

IF 2.3 3区医学 Q2 ANESTHESIOLOGY BMC Anesthesiology Pub Date : 2024-11-15 DOI:10.1186/s12871-024-02770-9

Eun Jung Kim, Kwan Kyu Park, Su Youn Choi, Hyang Mi Ju, Tae Lim Kim, Jeongmin Kim, Soo Yeon Kim, Bon-Nyeo Koo

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Abstract

Background: Post-operative delirium (PD) is a common post-operative complication with significant clinical and financial impacts on patients. Erythropoietin (EPO), a multi-functional glycoprotein hormone, exhibits erythropoietic and non-erythropoietic anti-inflammatory properties. This study aimed to determine the role of perioperative EPO administration in the development of postoperative delirium in older adult patients undergoing total joint arthroplasty.

Methods: Seventy-one patients (> 65 years old) scheduled for total joint arthroplasty were randomly assigned to two groups: EPO-treated (EPO, n = 35) and placebo (control, n = 36). All patients completed the Mini Mental State Examination (MMSE) pre-operatively and on post-operative day (POD) 2. The confusion assessment method (CAM) was used to assess the patients until discharge (POD 5). Serum C-reactive protein (CRP) and inflammatory cytokine levels were measured and compared pre- and post-operatively. The development of delirium and cognitive dysfunction was evaluated post-operatively.

Results: One patient in the control group developed delirium on POD 2 (3.2%), whereas no patient in the EPO group developed PD (0% vs. 3.2%, p = 0.500). Post-operatively there was no significant difference in MMSE scores between groups. Both groups showed increases in pro- and anti-inflammatory cytokine levels, with no significant differences. Similarly, CRP levels, neutrophil/lymphocyte ratio (NLR), and platelet/lymphocyte ratio (PLR) showed no intergroup differences in post-operative inflammatory responses.

Conclusions: Perioperative EPO reduced the incidence of post-operative delirium, although not statistically significant, with no differences in post-operative cognitive function and inflammatory responses.

Trial registration: The trial was registered on December 12, 2023 at http//clinicaltrials.gov, registration number NCT06178835.

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预防接受全关节置换术的老年患者术后神经认知障碍的促红细胞生成素：随机对照研究。

背景：术后谵妄（PD）是一种常见的术后并发症，对患者的临床和经济产生重大影响。促红细胞生成素（EPO）是一种多功能糖蛋白激素，具有促红细胞生成和非促红细胞生成的抗炎特性。本研究旨在确定围手术期服用 EPO 在接受全关节置换术的老年患者术后谵妄发展中的作用：71名计划接受全关节置换术的患者（65岁以上）被随机分配到两组：EPO治疗组（EPO，n = 35）和安慰剂组（对照组，n = 36）。所有患者均在术前和术后第 2 天（POD）完成迷你精神状态检查（MMSE），并在出院前（POD 5）使用混乱评估法（CAM）对患者进行评估。测量血清 C 反应蛋白（CRP）和炎症细胞因子水平，并对术前和术后进行比较。术后对谵妄和认知功能障碍的发展情况进行了评估：结果：对照组有一名患者在 POD 2 出现谵妄（3.2%），而 EPO 组没有患者出现谵妄（0% vs. 3.2%，P = 0.500）。术后，两组患者的 MMSE 评分无明显差异。两组患者的促炎和抗炎细胞因子水平均有所上升，但无明显差异。同样，CRP水平、中性粒细胞/淋巴细胞比值（NLR）和血小板/淋巴细胞比值（PLR）在术后炎症反应方面也未显示出组间差异：结论：围手术期 EPO 降低了术后谵妄的发生率，尽管没有统计学意义，但在术后认知功能和炎症反应方面没有差异：该试验于2023年12月12日在http//clinicaltrials.gov注册，注册号为NCT06178835。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

BMC Anesthesiology ANESTHESIOLOGY-

CiteScore

3.50

自引率

4.50%

发文量

349

审稿时长

>12 weeks

期刊介绍： BMC Anesthesiology is an open access, peer-reviewed journal that considers articles on all aspects of anesthesiology, critical care, perioperative care and pain management, including clinical and experimental research into anesthetic mechanisms, administration and efficacy, technology and monitoring, and associated economic issues.