Erythropoietin for the prevention of postoperative neurocognitive disorder in older adult patients undergoing total joint arthroplasty: a randomized controlled study
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...
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BMC
2024-11-01
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| Series: | BMC Anesthesiology |
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| Online Access: | https://doi.org/10.1186/s12871-024-02770-9 |
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| author | Eun Jung Kim Kwan Kyu Park Su Youn Choi Hyang Mi Ju Tae Lim Kim Jeongmin Kim Soo Yeon Kim Bon-Nyeo Koo |
| author_facet | Eun Jung Kim Kwan Kyu Park Su Youn Choi Hyang Mi Ju Tae Lim Kim Jeongmin Kim Soo Yeon Kim Bon-Nyeo Koo |
| author_sort | Eun Jung Kim |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-7c8deff506084f10a0b2bbcfaed26f69 |
| institution | Kabale University |
| issn | 1471-2253 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | BMC |
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| series | BMC Anesthesiology |
| spelling | doaj-art-7c8deff506084f10a0b2bbcfaed26f692024-11-17T12:45:33ZengBMCBMC Anesthesiology1471-22532024-11-012411810.1186/s12871-024-02770-9Erythropoietin for the prevention of postoperative neurocognitive disorder in older adult patients undergoing total joint arthroplasty: a randomized controlled studyEun Jung Kim0Kwan Kyu Park1Su Youn Choi2Hyang Mi Ju3Tae Lim Kim4Jeongmin Kim5Soo Yeon Kim6Bon-Nyeo Koo7Department of Anesthesiology and Pain Medicine, Yonsei University College of MedicineDepartment of Orthopedic Surgery, Severance Hospital, Yonsei University College of MedicineDepartment of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Yongin Severance HospitalDepartment of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Yongin Severance HospitalDepartment of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Yongin Severance HospitalDepartment of Anesthesiology and Pain Medicine, Yonsei University College of MedicineDepartment of Anesthesiology and Pain Medicine, Yonsei University College of MedicineDepartment of Anesthesiology and Pain Medicine, Yonsei University College of MedicineAbstract 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.https://doi.org/10.1186/s12871-024-02770-9ErythropoietinPostoperative neurocognitionPostoperative delirium |
| spellingShingle | Eun Jung Kim Kwan Kyu Park Su Youn Choi Hyang Mi Ju Tae Lim Kim Jeongmin Kim Soo Yeon Kim Bon-Nyeo Koo Erythropoietin for the prevention of postoperative neurocognitive disorder in older adult patients undergoing total joint arthroplasty: a randomized controlled study BMC Anesthesiology Erythropoietin Postoperative neurocognition Postoperative delirium |
| title | Erythropoietin for the prevention of postoperative neurocognitive disorder in older adult patients undergoing total joint arthroplasty: a randomized controlled study |
| title_full | Erythropoietin for the prevention of postoperative neurocognitive disorder in older adult patients undergoing total joint arthroplasty: a randomized controlled study |
| title_fullStr | Erythropoietin for the prevention of postoperative neurocognitive disorder in older adult patients undergoing total joint arthroplasty: a randomized controlled study |
| title_full_unstemmed | Erythropoietin for the prevention of postoperative neurocognitive disorder in older adult patients undergoing total joint arthroplasty: a randomized controlled study |
| title_short | Erythropoietin for the prevention of postoperative neurocognitive disorder in older adult patients undergoing total joint arthroplasty: a randomized controlled study |
| title_sort | erythropoietin for the prevention of postoperative neurocognitive disorder in older adult patients undergoing total joint arthroplasty a randomized controlled study |
| topic | Erythropoietin Postoperative neurocognition Postoperative delirium |
| url | https://doi.org/10.1186/s12871-024-02770-9 |
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