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Association between Preoperative hs-CRP/Albumin Ratio and Postoperative SIRS in Elderly Patients: A Retrospective Observational Cohort Study

  • Original Research
  • Published:
The journal of nutrition, health & aging

Abstract

Objectives

Systemic inflammatory response syndrome (SIRS) is one of the severe postoperative complications in elderly patients and seriously affects their prognosis and survival rate. Heretofore, there have been no reliable and accurate methods to predict postoperative SIRS in elderly patients. The aim of this study was to determine whether increased preoperative hs-CRP/albumin ratio (CAR) was associated with postoperative SIRS in elderly population.

Methods

The data of patients aged ≥ 65 years who underwent general anesthesia in two centers of Third Affiliated Hospital of Sun Yat-sen University between January 2015 and September 2020 were retrieved and analyzed. Based on the perioperative dataset, we used the targeted maximum likelihood estimation (TMLE) to estimate the association between preoperative CAR and postoperative SIRS in elderly population. Patients’ CAR was calculated and divided into two groups (< 0.278 and ≥ 0.278) according to its normal range in our hospital. Adjusted odd ratios (aORs) and 95% confidence intervals (CIs) were calculated respectively. Further sensitivity analyses were conducted to evaluate the robustness of the results.

Results

A total of 16141 elderly patients were accessed and 7009 of them were enrolled in the final analysis, and 1674 (23.9%) patients developed SIRS within 3 days after surgery. Compared with non-SIRS patients, patients with SIRS had a significantly longer postoperative hospitalization, higher cost and higher risk of in-hospital mortality. Compared with patients with preoperative CAR < 0.278, we found that CAR ≥ 0.278 had a significantly higher risk for the development of postoperative SIRS after multivariable adjustment [aOR = 1.27; 95% CI (1.21, 1.33)]. The interaction effect of preoperative CAR ≥ 0.278 and SIRS was stronger among patients with the following characteristics: aged ≥ 75 years, male, comorbid with diabetes mellitus and admitted to ICU after surgery, duration of surgery < 120 minutes, underwent cerebral surgery or skin, spine and joint surgery (all P < 0.001). The above results remained robust in the sensitivity analysis.

Conclusions

Preoperative CAR ≥ 0.278 was significantly associated with increased risk of postoperative SIRS in elderly patients. Special attention should be paid to elderly patients with a preoperative CAR ≥ 0.278 so as to reduce the incidence of postoperative SIRS.

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Availability of Data and Material

The raw data supporting the conclusions of this article will be made available by the corresponding authors via email.

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Funding

Funding: This study was supported partly by the National Natural Science Foundation of China (Grant No. 82102297 and 81974296), Postdoctoral Science Foundation of China (Grant No. 2019M663260) and Basic and Applied Basic Research Foundation of Guangdong Province (Grant No. 2019A1515110020).

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Author notes

  1. These authors contributed equally to the work.

Authors and Affiliations

  1. Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, Guangdong Province, People’s Republic of China, 510630

    C. Chen, X. Chen, J. Xing, Z. Hei & Shaoli Zhou

  2. Cell-gene Therapy Translational Medicine Research Center, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China

    C. Chen & Q. Zhang

  3. Clinical Data Center, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China

    J. Chen & Z. Liu

Authors
  1. C. Chen
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Contributions

Chaojin Chen,Ph.D. This author helped with research conceptualization and design, patient recruitment, data collection, data interpretation, and writing and final approval of the manuscript. Xiaorui Chen, M.M. This author helped with the literature research, data interpretation, and writing and final approval of the manuscript. Jingjing Chen,M.M. This author helped with the data analysis, data interpretation, and writing and final approval of the manuscript. Jibin Xing, M.D. This author helped with patient recruitment, data collection, data interpretation, and final approval of the manuscript. Ziqing Hei, Ph.D. This author helped with patient recruitment, data collection, data interpretation, and final approval of the manuscript. Qi Zhang, M.D. This author helped with patient recruitment, data collection, data interpretation, and final approval of the manuscript. Zifeng Liu, M.D. This author helped with research conceptualization and design, data analysis, and writing and final approval of the manuscript. Shaoli Zhou, M.D. This author helped with research conceptualization and design and writing and final approval of the manuscript.

Corresponding author

Correspondence to Shaoli Zhou.

Ethics declarations

This study was approved by the Institutional Ethics Committee from the two hospitals and was censored on 14 May 2021 (No.[2019]02-609-02). The requirement for informed consent and clinical trial registration were waived by the committee.

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Conflicts of Interest

The authors declare that they have no conflicts of interest.

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Chen, C., Chen, X., Chen, J. et al. Association between Preoperative hs-CRP/Albumin Ratio and Postoperative SIRS in Elderly Patients: A Retrospective Observational Cohort Study. J Nutr Health Aging 26, 352–359 (2022). https://doi.org/10.1007/s12603-022-1761-4

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  • DOI: https://doi.org/10.1007/s12603-022-1761-4

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