Vascular Health and Risk Management (Nov 2021)

An Association Between C-Reactive Protein Levels and the Occurrence of Cognitive Dysfunction After Heart Valve Replacement

  • Nurcahyo WI,
  • Arifin A,
  • Primatika AD,
  • Muttaqin Z,
  • Elfira Boom C,
  • Harahap MS,
  • Mochamat M,
  • Eko Nugroho T,
  • Wicaksono SA

Journal volume & issue
Vol. Volume 17
pp. 713 – 720

Abstract

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Widya Istanto Nurcahyo,1 Anshoril Arifin,1 Aria Dian Primatika,1 Zainal Muttaqin,2 Cindy Elfira Boom,3 M Sofyan Harahap,1 Mochamat Mochamat,1 Taufik Eko Nugroho,1 Satrio Adi Wicaksono1 1Department of Anesthesiology and Intensive Care, Diponegoro University Faculty of Medicine/Dr. Kariadi General Hospital, Semarang City, Central Java Province, Indonesia; 2Department of Neurosurgery, Faculty of Medicine, Diponegoro University/Dr. Kariadi General Hospital, Semarang City, Central Java Province, Indonesia; 3Department of Anesthesiology and Intensive Care, Cardiovascular Centre, Harapan Kita Hospital, Jakarta, IndonesiaCorrespondence: Widya Istanto NurcahyoDepartment of Anesthesiology and Intensive Care, Diponegoro University Faculty of Medicine/Dr. Kariadi General Hospital, Semarang City, Central Java Province, 50275, IndonesiaFax +62 2476928010Email [email protected]; [email protected]: Postoperative cognitive dysfunction (POCD) is defined as cognitive dysfunction related to inflammation after surgical procedures, which is common following cardiac surgery. Cognitive deficits are thought to result from a systemic inflammatory response. C-reactive protein (CRP) and other proinflammatory cytokines, which are released in response to inflammation, disrupt the blood–brain barrier and neurotransmission, resulting in POCD. This study aimed to determine the correlation between POCD and increased levels of CRP in patients who had undergone heart valve replacement.Methods: This study comprised 32 patients with normal cognitive function undergoing heart valve replacement. The CRP levels were measured before surgery and on the second postoperative day, and cognitive function was examined via the Indonesian-adapted Montreal Cognitive Assessment (MOCA-INA) on the third postoperative day. Data were analyzed using Spearman correlation test.Results: Of the 32 patients, 28 (87.5%) experienced POCD. The median level of CRP was 6.6 mg/dL (interquartile range: 4.0, 8.3 g/dL). According to Spearman correlation test, increased levels of CRP were significantly related to POCD following heart valve replacement (p = 0.003, r = 0.501). The receiver operating characteristic curve indicated that the CRP cutoff level was 3.345 mg/dL, and the sensitivity and specificity were 89.3% and 75%, respectively.Conclusion: High expression level of CRP was correlated with POCD following heart valve replacement.Keywords: C-reactive protein, cardiac surgical procedure, cognition disorders, cognitive dysfunction, heart valves, postoperative complication

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