Combination of Creatinine with Inflammatory Biomarkers (PCT, CRP, hsCRP) for Predicting Postoperative ICU Admissions for Elderly Patients

Yali Chen; Yi Teng; Xiran Peng; Tao Zhu; Juan Liu; Mengchan Ou; Xuechao Hao

doi:10.1007/s12325-024-02874-1

Combination of Creatinine with Inflammatory Biomarkers (PCT, CRP, hsCRP) for Predicting Postoperative ICU Admissions for Elderly Patients

Adv Ther. 2024 May 14. doi: 10.1007/s12325-024-02874-1. Online ahead of print.

Authors

Yali Chen^#^{1

2}, Yi Teng^#^{1

2}, Xiran Peng^{1

2}, Tao Zhu^{1

2}, Juan Liu^{1

2}, Mengchan Ou^{3

4}, Xuechao Hao^{5

6}

Affiliations

¹ Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China.
² Research Unit for Perioperative Stress Assessment and Clinical Decision, Chinese Academy of Medical Sciences (2018RU012), West China Hospital, Sichuan University, Chengdu, China.
³ Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China. oumengchan@foxmail.com.
⁴ Research Unit for Perioperative Stress Assessment and Clinical Decision, Chinese Academy of Medical Sciences (2018RU012), West China Hospital, Sichuan University, Chengdu, China. oumengchan@foxmail.com.
⁵ Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China. aneshxc@163.com.
⁶ Research Unit for Perioperative Stress Assessment and Clinical Decision, Chinese Academy of Medical Sciences (2018RU012), West China Hospital, Sichuan University, Chengdu, China. aneshxc@163.com.

^# Contributed equally.

PMID: 38743240
DOI: 10.1007/s12325-024-02874-1

Abstract

Introduction: The number of elderly patients who require surgery as their primary treatment has increased rapidly in recent years. Among 300 million people globally who underwent surgery every year, patients aged 65 years and over accounted for more than 30% of cases. Despite medical advances, older patients remain at higher risk of postoperative complications. Early diagnosis and effective prediction are essential requirements for preventing serious postoperative complications. In this study, we aim to provide new biomarker combinations to predict the incidence of postoperative intensive care unit (ICU) admissions > 24 h in elderly patients.

Methods: This investigation was conducted as a nested case-control study, incorporating 413 participants aged ≥ 65 years who underwent non-cardiac, non-urological elective surgeries. These individuals underwent a 30-day postoperative follow-up. Before surgery, peripheral venous blood was collected for analyzing serum creatinine (Scr), procalcitonin (PCT), C-reactive protein (CRP), and high-sensitivity CRP (hsCRP). The efficacy of these biomarkers in predicting postoperative complications was evaluated using receiver operating characteristic (ROC) curve analysis and area under the curve (AUC) values.

Results: Postoperatively, 10 patients (2.42%) required ICU admission. Regarding ICU admissions, the AUCs with 95% confidence intervals (CIs) for the biomarker combinations of Scr × PCT and Scr × CRP were 0.750 (0.655-0.845, P = 0.007) and 0.724 (0.567-0.882, P = 0.015), respectively. Furthermore, cardiovascular events were observed in 14 patients (3.39%). The AUC with a 95% CI for the combination of Scr × CRP in predicting cardiovascular events was 0.688 (0.560-0.817, P = 0.017).

Conclusion: The innovative combinations of biomarkers (Scr × PCT and Scr × CRP) demonstrated efficacy as predictors for postoperative ICU admissions in elderly patients. Additionally, the Scr × CRP also had a moderate predictive value for postoperative cardiovascular events.

Trial registration: China Clinical Trial Registry, ChiCTR1900026223.

Keywords: C-reactive protein; High-sensitivity C-reactive protein; Postoperative ICU admissions; Procalcitonin; Serum creatinine.

Abstract

Grants and funding