C-reactive protein to albumin ratio as a novel inflammatory biomarker for postoperative delirium in patients undergoing transcatheter aortic valve replacement

Abstract

Aim: We aimed to investigate whether C-reactive protein-to-albumin ratio (CAR) predicts postoperative delirium (POD) development in patients undergoing transcatheter aortic valve replacement (TAVR) procedure. Methods: Data of 78 patients with the mean age of 76.3±8.4 years, who underwent TAVR, were retrospectively analyzed. The CAR, neurophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio values were calculated in all patients. Presence of delirium was determined by using the Richmond Agitation-sedation scale and the Confusion Assessment Method for the Intensive Care Unit. Results: As compared with the nondelirious group, delirious patients had significantly higher EuroSCORE II (p=0.03) and TAVR score (p=0.009) and more frequent major bleeding (p=0.005), major vascular complications (p=0.018) and acute kidney injury (AKI) (p=0.002). The main independent predictors of POD were CAR value (p=0.02), AKI (p=0.02), major bleeding (p=0.005), and TAVR score (p=0.04). The area under the curve of CAR for POD development was 0.718 (95% confidence interval: 0.605-0.814; p=0.002) with 82% sensitivity and 56% specificity. Conclusion: CAR is a promising inflammatory parameter in predicting POD and may help identify subgroups of individuals at risk for POD.