Resolution of elevated interleukin-6 after surgery is associated with return of normal cognitive function.
Resolution of elevated interleukin-6 after surgery is associated with return of normal cognitive function.
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DOI：
10.1016/j.bja.2023.05.023
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发表时间：
2023-06
影响因子：
9.8
通讯作者：
Jennifer Taylor;J. Wu;David Kunkel;Margaret Parker;Cameron A. Rivera;Cameron P. Casey;S. Naismith;A. Teixeira-Pinto;M. Maze;R. Pearce;R. Lennertz;Robert D. Sanders
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文献类型：
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作者：
Jennifer Taylor;J. Wu;David Kunkel;Margaret Parker;Cameron A. Rivera;Cameron P. Casey;S. Naismith;A. Teixeira-Pinto;M. Maze;R. Pearce;R. Lennertz;Robert D. Sanders
未解决的外科炎症可能导致老年人的慢性认知能力下降。虽然炎症生物标志物与围手术期认知障碍和谵妄相关，但长期炎症对认知的影响尚未得到充分研究。这项前瞻性队列研究调查1年动态血浆白细胞介素-6水平和执行function.MethodsPatients接受大手术（n=170）年龄≥65岁完成连线测试B和其他神经心理学评估与血浆白细胞介素-6水平收集术后第1-9天和90，并在1年。对连线试验B进行了混合效应分析（和其他评估），包括白细胞介素-6水平、时间和其他混杂因素结果在广义相加模型中，白细胞介素-6水平的变化与1年内连线测验B的变化相关（β= 0.074，P <0.001）支持未消退的炎症损害执行功能。该结果对混杂因素、离群值拒绝和非线性模型拟合具有稳健性。白细胞介素-6水平的变化也与连线测验A和控制性口语词汇联想测验的变化相关。对认知功能下降的二进制定义进行的敏感性分析（>1，>1.5，或>2个标准差，从基线）也与白细胞介素-6的changes.ConclusionsDelayed分辨率炎症与术后认知功能障碍。监测白细胞介素-6可能提供一个机会，在脆弱的患者抗炎治疗干预。临床试验注册NCT 01980511，NCT 03124303。
BackgroundUnresolved surgical inflammation might induce chronic cognitive decline in older adults. Although inflammatory biomarkers have been correlated with perioperative cognitive impairment and delirium, the effects of prolonged inflammation on cognition are not well studied. This prospective cohort study investigated 1-yr dynamics in plasma interleukin-6 levels and executive function.MethodsPatients undergoing major surgery (n=170) aged ≥65 yr completed Trail Making Test B and other neuropsychological assessments with plasma interleukin-6 levels collected on postoperative days 1–9 and 90, and at 1-yr. Mixed-effects analyses were conducted for Trail Making Test B (and other assessments), including interleukin-6 levels, time, and additional confounders (fixed effects), and a random effect for participant.ResultsChanges in interleukin-6 levels were associated with changes in Trail Making Test B over 1 yr in a generalised additive model (β=0.074,P<0.001) supporting that unresolved inflammation impaired executive function. This result was robust to confounders, outlier rejection, and fitting to non-linear models. Changes in interleukin-6 levels also correlated with changes in Trail Making Test A and Controlled Oral Word Association Test. Sensitivity analyses conducted on binary definitions of cognitive decline (>1, >1.5, or >2 standard deviations from baseline) were also associated with interleukin-6 changes.ConclusionsDelayed resolution of inflammation is associated with cognitive impairment after surgery. Monitoring interleukin-6 might provide an opportunity to intervene with anti-inflammatory therapies in vulnerable patients.Clinical trial registrationNCT01980511, NCT03124303.