Presence of Preoperative Neurodegeneration Biofluid Markers in Patients with Postoperative Delirium.
Presence of Preoperative Neurodegeneration Biofluid Markers in Patients with Postoperative Delirium.
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术后谵妄患者术前神经变性生物流体标志物的存在。
DOI：
10.1097/aln.0000000000004666
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发表时间：
2023
期刊：
影响因子：
8.8
通讯作者：
PerioperativeMedicineResearchGroup
中科院分区：
文献类型：
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作者：
Leung,JacquelineM;Rojas,JulioC;Tang,Christopher;Chan,Brandon;Lario-Lago,Argentina;Boxer,AdamL;Do,Quyen;Kramer,JoelH;Du,Zhiyuan;Du,Pang;Sands,LauraP;PerioperativeMedicineResearchGroup
背景谵妄的病理生理机制还不完全清楚，包括哪些分子通路参与了大脑对谵妄的易感性。我们确定是否术前血浆神经变性标志物升高的患者随后发展术后谵妄通过回顾性病例对照study.MethodsInclusion标准为患者≥65岁，接受择期非心脏手术，住院时间≥ 2天。采用数字化免疫分析平台检测术前血浆P-tau 181、神经丝轻链（NfL）、淀粉样蛋白β1-42（Aβ42）和胶质细胞酸性蛋白（GFAP）浓度。主要结局是通过意识模糊评估方法测量的术后谵妄。我们做了一个倾向得分匹配的年龄和性别与最近的邻居，使每个患者在谵妄组匹配的年龄和性别与患者在no delirium group.ResultsOur初始队列由189例患者没有谵妄和102例患者术后谵妄。在291例年龄为72.5 ± 5.8岁的患者中，50.5%为女性，102例（35%）发生术后谵妄。分析中的最后一个队列包括无谵妄（n=102）和谵妄（n=102）组，使用倾向评分法在年龄和性别上匹配。在测定的四种生物标志物中，谵妄组的NfL的中值为32.05 pg/ml，而无谵妄组为23.7 pg/ml。生物标志物值的分布在谵妄组和无谵妄组之间有显著差异（Kolmogorov-Smirnov检验的p值=0.02），最大的累积概率差异出现在生物标志物值32.05 pg/ml。结论这些结果表明，随后发生谵妄的患者更有可能在手术前经历临床无症状的神经退行性变化，通过血浆NfL生物标志物浓度的变化反映，这可以识别具有对随后的认知下降的术前脆弱性的个体。
BackgroundThe pathophysiology of delirium is incompletely understood including what molecular pathways are involved in brain vulnerability to delirium. We determined whether preoperative plasma neurodegeneration markers were elevated in patients who subsequently developed postoperative delirium through a retrospective case-control study.MethodsInclusion criteria were patients ≥65 years of age, undergoing elective noncardiac surgery with a hospital stay of ≥ two days. Concentrations of preoperative plasma P-tau181, neurofilament light chain (NfL), amyloid β1–42 (Aβ42), and glial fibrillary acidic protein (GFAP) concentrations were measured with digital immunoassay platform. The primary outcome was postoperative delirium measured by the Confusion Assessment Method. We did a propensity score matching on age and sex with nearest neighbor such that each patient in the delirium group was matched on age and sex with a patient in the no delirium group.ResultsOur initial cohort consists of 189 patients with no delirium and 102 patients who developed postoperative delirium. Of 291 patients aged 72.5 ± 5.8 years, 50.5% were women, and 102 (35%) developed postoperative delirium. The final cohort in the analysis consisted of a no delirium (n=102) and a delirium (n=102) groups matched on age and sex using the propensity score method. Of the four biomarkers assayed, the median value for NfL was 32.05 pg/ml for the delirium group vs. 23.7 pg/ml in the no delirium group. The distribution of biomarker values significantly differed between the delirium and no delirium groups (p-value =0.02 by the Kolmogorov-Smirnov test) with the largest cumulative probability difference appearing at the biomarker value of 32.05 pg/ml.ConclusionsThese results suggest that patients who subsequently developed delirium are more likely to be experiencing clinically silent neurodegenerative changes before surgery, reflected by changes in plasma NfL biomarker concentrations, which may identify individuals with a preoperative vulnerability to subsequent cognitive decline.