The association of C-Reactive Protein with Delirium Severity: An analysis of a prospective cohort study

Abstract

BackgroundPostoperative delirium (POD) is common in elderly patients and is linked to poor recovery and greater mortality. Inflammation has been implicated in its pathophysiology and recent meta-analysis suggests steroids may have utility in preventing POD. This study aimed to evaluate whether C-reactive protein (CRP) predicts severity (or incidence) of POD. Our secondary outcome analysed whether anti-emetic doses of dexamethasone meaningfully altered inflammatory responses in this age group.

MethodsPatients (n=122) [≥]60 years of age undergoing major surgery were recruited to a prospective cohort study in which CRP was measured preoperatively and on postoperative day 1. Delirium was assessed using the 3-minute diagnostic Confusion Assessment Method (3D-CAM) twice daily on days 1-3. CRP was analysed against the outcomes of incidence (positive overall 3D-CAM) and peak severity (maximum 3D-CAM score) of POD.

ResultsPOD occurred in 20/122 (16.4%); mean peak severity 2.1 (SD 2.1). Postoperative CRP was associated with the primary outcome, POD severity (predicted probability 94.7%) as well as incidence (predicted probability 99.9%). Dexamethasone reduced CRP by 41% (95% CrI 8-62%, predicted probability 99.1%).

ConclusionRoutine postoperative CRP was independently associated with POD incidence and severity. Dexamethasone, at anti-emetic doses, was associated with a substantial reduction in CRP levels, supporting trials focussed on modulating inflammation to prevent delirium.

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BibTeX RIS

BibTeX

@misc{schnitzler2026association,
  title = {{The association of C-Reactive Protein with Delirium Severity: An analysis of a prospective cohort study}},
  author = {F. Schnitzler and K. Kramer and S. Curtis and B. Anderson and K. Matsis and A. Lawrence and G. Wong and B. Moran and N. Pillinger and R. Sanders},
  howpublished = {medRxiv},
  year = {2026},
  month = oct,
  doi = {10.64898/2026.10.22.26366074},
  url = {https://www.medrxiv.org/content/10.64898/2026.10.22.26366074v1},
  note = {CC BY-NC-ND},
}

RIS

TY  - UNPB
TI  - The association of C-Reactive Protein with Delirium Severity: An analysis of a prospective cohort study
AU  - F. Schnitzler
AU  - K. Kramer
AU  - S. Curtis
AU  - B. Anderson
AU  - K. Matsis
AU  - A. Lawrence
AU  - G. Wong
AU  - B. Moran
AU  - N. Pillinger
AU  - R. Sanders
PY  - 2026
DA  - 2026/10/22
PB  - medRxiv
DO  - 10.64898/2026.10.22.26366074
UR  - https://www.medrxiv.org/content/10.64898/2026.10.22.26366074v1
AB  - BackgroundPostoperative delirium (POD) is common in elderly patients and is linked to poor recovery and greater mortality. Inflammation has been implicated in its pathophysiology and recent meta-analysis suggests steroids may have utility in preventing POD. This study aimed to evaluate whether C-reactive protein (CRP) predicts severity (or incidence) of POD. Our secondary outcome analysed whether anti-emetic doses of dexamethasone meaningfully altered inflammatory responses in this age group.  MethodsPatients (n=122) [≥]60 years of age undergoing major surgery were recruited to a prospective cohort study in which CRP was measured preoperatively and on postoperative day 1. Delirium was assessed using the 3-minute diagnostic Confusion Assessment Method (3D-CAM) twice daily on days 1-3. CRP was analysed against the outcomes of incidence (positive overall 3D-CAM) and peak severity (maximum 3D-CAM score) of POD.  ResultsPOD occurred in 20/122 (16.4%); mean peak severity 2.1 (SD 2.1). Postoperative CRP was associated with the primary outcome, POD severity (predicted probability 94.7%) as well as incidence (predicted probability 99.9%). Dexamethasone reduced CRP by 41% (95% CrI 8-62%, predicted probability 99.1%).  ConclusionRoutine postoperative CRP was independently associated with POD incidence and severity. Dexamethasone, at anti-emetic doses, was associated with a substantial reduction in CRP levels, supporting trials focussed on modulating inflammation to prevent delirium.
ER  -

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