Cystatin C level as a prognostic risk factor for postoperative complications in elderly patients
Annotation. An important criterion for assessing the course of urgent surgical pathology in elderly patients is the concomitant state of sarcopenia. Decreased blood levels of cystatin C, which correlates with decreased muscle mass and strength, is an important screening criterion for perioperative intensive care therapy in these patients. The aim of the study was to increase the effectiveness of intensive care in patients with low sarcopenic index by improving the methods of influencing perioperative risk factors. We examined 90 elderly patients (73.3±7.9 years) with surgical pathology of the abdominal cavity, who underwent emergency surgery under general anesthesia based on sodium thiopental with artificial lung ventilation. Patients were divided into 3 randomized groups by age, sex, anthropometric data, volume and duration of surgery, concomitant comorbid background and perioperative intensive care: group I (n=30) – patients undergoing standard intensive perioperative therapy, group II (n=30) – standard intensive care with the addition of levocarnitine; group III (n=30) – standard intensive care with the addition of levocarnitine and a solution of D-fructose-1,6-diphosphate sodium salt hydrate. Muscle mass was determined by bioimpedancemetry on the analyzer “MEDASS” ABC-02, muscle strength was assessed by wrist dynamometry, muscle-skeletal mass index was calculated. The serum cystatin C concentration was determined by latex-enhanced immunoturbidimetry (DIALAB GmbH, Austria). The significance of the obtained data was checked using the r-Pearson correlation coefficient. It is established that additional prescription of levocarnitine and D-fructose-1,6-diphosphate sodium hydrate salt significantly reduces the number of days of treatment in the intensive care unit, improves prognosis, and promotes early activation of patients. Metabolic changes caused by a decreased sarcopenic index require further research.
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