Journal of psychiatric research · 2025
Effects of different doses of glucocorticoids on postoperative neurocognitive function and mood disorders: A systematic Review and network meta-analysis.
СтатьяСистематический обзорNetwork Meta-AnalysisНазвание и аннотация: Перевод пока не подготовлен
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Fan Yingying, Li Jiaqi, Luo Ruoyu, Hao Liwen, Yuan Chaoyun, Jing Jiyong
Аннотация
BACKGROUND: Perioperative Neurocognitive Disorder and mood disorders have emerged as significant concerns impacting the quality of postoperative recovery. Ongoing research is focused on identifying pharmacological interventions to prevent postoperative PND and mood disorders. Glucocorticoids are extensively employed during the perioperative period; however, their effects on neurocognitive and psychological functions remain a matter of debate.
METHODS: We conducted a comprehensive search of PubMed, Cochrane Library, EMBASE, and Web of Science from their inception to December 30, 2024, focusing on the use of various doses of corticosteroids during the perioperative period.
RESULTS: A total of 25 studies, encompassing 17,378 patients, were included in the analysis. The administration of glucocorticoids significantly reduced the incidence of postoperative delirium (RR = 0.85, 95 %CI = 0.77 to 0.95, P = 0.002, I2 = 41.5 %). Additionally, it decreased the severity of delirium (SMD = -0.66, 95 %CI = -0.84 to -0.48, P < 0.01, I2 = 92 %). The use of GCs (RR = 0.86, 95 %CI = 0.71 to 1.05, P = 0.132, I2 = 25.2 %) did not significantly reduce the occurrence of mood disorders. In the high-dose group, GCs significantly lowered the incidence of delirium (RR = 0.79, 95 %CI = 0.63 to 0.99). Meanwhile, medium-dose GCs notably reduced the incidence of postoperative cognitive dysfunction (RR = 0.70, 95 %CI = 0.37 to 1.35) (RR = 0.58, 95 %CI = 0.36 to 0.92).
CONCLUSION: The use of glucocorticoids during the perioperative period significantly reduced the incidence and severity of postoperative delirium. The effects of different doses of glucocorticoids on postoperative neurocognitive and psychological status varied. The perioperative administration of medium-dose glucocorticoids appears to be safer and has the potential to prevent postoperative neurocognitive dysfunction.
METHODS: We conducted a comprehensive search of PubMed, Cochrane Library, EMBASE, and Web of Science from their inception to December 30, 2024, focusing on the use of various doses of corticosteroids during the perioperative period.
RESULTS: A total of 25 studies, encompassing 17,378 patients, were included in the analysis. The administration of glucocorticoids significantly reduced the incidence of postoperative delirium (RR = 0.85, 95 %CI = 0.77 to 0.95, P = 0.002, I2 = 41.5 %). Additionally, it decreased the severity of delirium (SMD = -0.66, 95 %CI = -0.84 to -0.48, P < 0.01, I2 = 92 %). The use of GCs (RR = 0.86, 95 %CI = 0.71 to 1.05, P = 0.132, I2 = 25.2 %) did not significantly reduce the occurrence of mood disorders. In the high-dose group, GCs significantly lowered the incidence of delirium (RR = 0.79, 95 %CI = 0.63 to 0.99). Meanwhile, medium-dose GCs notably reduced the incidence of postoperative cognitive dysfunction (RR = 0.70, 95 %CI = 0.37 to 1.35) (RR = 0.58, 95 %CI = 0.36 to 0.92).
CONCLUSION: The use of glucocorticoids during the perioperative period significantly reduced the incidence and severity of postoperative delirium. The effects of different doses of glucocorticoids on postoperative neurocognitive and psychological status varied. The perioperative administration of medium-dose glucocorticoids appears to be safer and has the potential to prevent postoperative neurocognitive dysfunction.