Association of nociception index with postoperative immune status: a prospective observational study

Anesthesiology and Perioperative Science Pub Date : 2025-05-21 DOI:10.1007/s44254-025-00104-7

Yanling Zhang, Anhui Zha, Weiyun Shen, Ruping Dai

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Abstract

Purpose

Electroencephalography (EEG) is commonly used to assess sedation levels in general anesthesia, but its ability to indicate perioperative trauma and inflammation activation levels remains unclear. This study examines the relationship between the nociception index (NOX), an EEG-derived metric, and related immune changes in surgical patients.

Methods

Patients aged 18 to 75 years scheduled for elective surgery under general anesthesia, without chronic pain, hepatic or renal dysfunction, pregnancy, intensive care unit stay, and a postoperative stay of less than 1 day. We investigated the relationship between the NOX and immune-inflammatory parameters in surgical patients. NOX and bispectral index (BIS) values were recorded upon post-anesthesia care unit admission and after awakening from anesthesia. We collected immune-related indicators, including immune cell counts in routine blood tests, C-reactive protein (CRP) levels, hemoglobin, and the length of postoperative hospital stay. The association of NOX with inflammatory response from surgical stimulation and postoperative prognosis was assessed.

Results

A total of 100 patients were included in the analysis. NOX value is positively associated with immune-inflammatory parameters, such as the postoperative CRP level (R = 0.3313, P = 0.0002), changes in monocyte counts (R = 0.3078, P = 0.0009), and changes in hemoglobin (R = 0.4036, P < 0.0001) before and one day after surgery, whereas the BISpro index is not associated with these parameters (All P > 0.05). In comparison to patients with NOX values lower than the BISpro values, patients with NOX values exceeding BISpro levels showed elevated levels of immune-related indicators, such as CRP level (P = 0.0182), monocyte count (P = 0.0357), and changes in hemoglobin before and one day after surgery (P = 0.0234). The variation of NOX (△NOX) negatively correlates with the CRP level (R = –0.2708, P = 0.0073), changes in monocyte numbers (R = –0.3606, P = 0.0002), changes in hemoglobin (R = –0.3083, P < 0.0001), and postoperative hospital stay (R = –0.1882, P = 0.0327).

Conclusions

Our study demonstrates that, as an EEG index, NOX and its dynamic variation may be associated with the inflammatory response induced by surgical trauma, potentially offering insights into postoperative immune status.

Trial registration

Registered at the Chinese Clinical Trial Registry (ChiCTR, https://www.chictr.org.cn/showproj.html?proj=199672) with No. ChiCTR2300074319.

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伤害感觉指数与术后免疫状态的关联：一项前瞻性观察研究

目的脑电图（EEG）通常用于评估全身麻醉的镇静水平，但其提示围手术期创伤和炎症激活水平的能力尚不清楚。本研究探讨了手术患者的伤害感受指数（NOX）（一种脑电图衍生的指标）与相关免疫变化之间的关系。方法患者年龄18 ~ 75岁，全麻下择期手术，无慢性疼痛、肝肾功能障碍、妊娠、重症监护，术后住院时间小于1天。我们研究了外科患者NOX与免疫炎症参数的关系。在麻醉后护理单位入院和麻醉醒来后记录NOX和双谱指数（BIS）值。我们收集了免疫相关指标，包括常规血液检查中的免疫细胞计数、c反应蛋白（CRP）水平、血红蛋白和术后住院时间。评估NOX与手术刺激引起的炎症反应和术后预后的关系。结果共纳入100例患者。NOX值与术前及术后1天免疫炎性参数如术后CRP水平（R = 0.3313, P = 0.0002）、单核细胞计数变化（R = 0.3078, P = 0.0009）、血红蛋白变化（R = 0.4036, P < 0.0001）呈正相关，而BISpro指数与这些参数无相关性（均P >； 0.05）。与NOX值低于BISpro的患者相比，NOX值超过BISpro的患者的免疫相关指标，如CRP水平（P = 0.0182）、单核细胞计数（P = 0.0357）、手术前和术后1天血红蛋白变化（P = 0.0234）均升高。NOX（△NOX）的变化与CRP水平（R = -0.2708, P = 0.0073）、单核细胞数量变化（R = -0.3606, P = 0.0002）、血红蛋白变化（R = -0.3083, P < 0.0001）、术后住院时间（R = -0.1882, P = 0.0327）呈负相关。结论我们的研究表明，作为脑电图指标，NOX及其动态变化可能与手术创伤引起的炎症反应有关，可能为术后免疫状态提供线索。在中国临床试验注册中心注册（ChiCTR, https://www.chictr.org.cn/showproj.html?proj=199672），注册号：ChiCTR2300074319。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Anesthesiology and Perioperative Science

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