Postoperative delirium and its relationship with biomarkers for dementia: a meta-analysis

Wang, Sophia; Greene, Ryan; Song, Yiqing; Chan, Carol K.; Lindroth, Heidi; Khan, Sikandar; Rios, Gabriel R.; Sanders, Robert D.; Khan, Babar

doi:10.1017/s104161022100274x

Cited by 18 publications

(17 citation statements)

References 58 publications

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“…S-100β has been found to be significantly elevated in the serum of patients who have experienced or are experiencing delirium ( Khan et al, 2021 ), suggesting that there might be a close relationship between delirium and nerve injury and that factors such as surgery, hemorrhage, anesthetic drugs, and perioperative hypoperfusion might cause cerebral injury and contribute to the development of delirium. It has been reported that S-100β in the blood is positively correlated with the occurrence of POD ( Wang et al, 2022 ). Axons release small amounts of NfL—an important component subunit of neuronal neurofilament proteins—under normal physiological conditions, but under pathological conditions, the synthesis and release of NfL increases significantly.…”

Section: Discussionmentioning

confidence: 99%

The effect of parecoxib sodium on postoperative delirium in elderly patients with hip arthroplasty

Wang

Liu²,

Yongquan³

et al. 2023

Front. Pharmacol.

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Objective: This study aimed to clarify the effect of parecoxib sodium on the occurrence of postoperative delirium and to investigate its possible mechanism.Methods: A total of 80 patients who underwent elective hip arthroplasty in our hospital between December 2020 and December 2021 were selected and randomly divided into two groups: a parecoxib sodium group (group P, n = 40) and a control group (group C, n = 40). Patients in group P were intravenously injected with 40 mg of parecoxib sodium 30 min before anesthesia and at the end of the surgery. Patients in group C were intravenously injected with the same volume of normal saline at the same time points. The primary endpoint was the incidence of POD, and the secondary endpoints were the levels of inflammatory factors (tumor necrosis factor- α [TNF-α], interleukin [IL]-1β, IL-6, and IL-10), nerve injury-related factors (brain-derived neurotrophic factor [BDNF], S-100β protein, neuron-specific enolase [NSE], and neurofilament light chain [NfL]), and antioxidant factors (heme oxygenase-1 [HO-1]), as well as the Visual Analogue Scale (VAS) and Confusion Assessment Method-Chinese Reversion (CAM-CR) scores.Results: The incidence of POD was 10% in group P and 27.5% in group C. Intergroup comparison revealed that the levels of TNF-α, IL-1β, S-100β, NfL, and NSE were lower, and BDNF was higher, in group P than in group C at each postoperative time point. The levels of IL-6 were lower, and the levels of IL-10 and HO-1 were higher, in group P than in group C at 1 h and 1 day postoperatively (p < 0.05). Three days after surgery, the differences in the levels of IL-6, IL-10, and HO-1 were not statistically significant between the two groups (p > 0.05). The VAS and CAM-CR scores were lower at each postoperative time point in group P than in group C (p < 0.05).Conclusion: Parecoxib sodium could reduce postoperative pain, decrease the plasma levels of inflammatory and nerve injury-related factors, upregulate HO-1 levels, and reduce the incidence of POD. The results of this study suggest that parecoxib sodium may reduce the occurrence of POD through the effects of anti-inflammation, analgesia, and antioxidants.

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Section: Discussionmentioning

confidence: 99%

The effect of parecoxib sodium on postoperative delirium in elderly patients with hip arthroplasty

Wang

Liu²,

Yongquan³

et al. 2023

Front. Pharmacol.

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“…Researchers have conducted a number of clinical studies to identify biomarkers accurately predicting PODs, such as the evaluation of plasma tau, 31 the S‐100β protein, 32 amyloid, 33 adiponectin 34 levels, and the level of PGRN in the cerebrospinal fluid. 35 Researchers are also trying to determine how to reduce the prevalence of the condition.…”

Section: Discussionmentioning

confidence: 99%

Automated machine learning‐based model for the prediction of delirium in patients after surgery for degenerative spinal disease

et al. 2022

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Objective This study used machine learning algorithms to identify critical variables and predict postoperative delirium (POD) in patients with degenerative spinal disease. Methods We included 663 patients who underwent surgery for degenerative spinal disease and received general anesthesia. The LASSO method was used to screen essential features associated with POD. Clinical characteristics, preoperative laboratory parameters, and intraoperative variables were reviewed and were used to construct nine machine learning models including a training set and validation set (80% of participants), and were then evaluated in the rest of the study sample (20% of participants). The area under the receiver‐operating characteristic curve (AUROC) and Brier scores were used to compare the prediction performances of different models. The eXtreme Gradient Boosting algorithms (XGBOOST) model was used to predict POD. The SHapley Additive exPlanations (SHAP) package was used to interpret the XGBOOST model. Data of 49 patients were prospectively collected for model validation. Results The XGBOOST model outperformed the other classifier models in the training set (area under the curve [AUC]: 92.8%, 95% confidence interval [CI]: 90.7%–95.0%), validation set (AUC: 87.0%, 95% CI: 80.7%–93.3%). This model also achieved the lowest Brier Score. Twelve vital variables, including age, serum albumin, the admission‐to‐surgery time interval, C‐reactive protein level, hypertension, intraoperative blood loss, intraoperative minimum blood pressure, cardiovascular‐cerebrovascular disease, smoking, alcohol consumption, pulmonary disease, and admission‐intraoperative maximum blood pressure difference, were selected. The XGBOOST model performed well in the prospective cohort (accuracy: 85.71%). Conclusion A machine learning model and a web predictor for delirium after surgery for the degenerative spinal disease were successfully developed to demonstrate the extent of POD risk during the perioperative period, which could guide appropriate preventive measures for high‐risk patients.

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“…Collectively, this study showed that postoperative CRP level was a good predictor for POD in CRC patients, which was in consistent with the results by previous meta-analyses. 15,17 Age was a well-established risk factor for delirium, and was an independent predictor for delirium. [46][47][48][49] As expected, we found that older age (> 70 years) was a risk factor for POD in patients with CRC by multivariate analysis, which was not shown in the study by Xiang et al 36 They showed that the age was a risk factor for POD in univariate analysis, but not in multivariate analysis, 36 , which might be due to limited sample size or clinical heterogeneity.…”

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confidence: 99%

Postoperative C-Reactive Protein Predicts Postoperative Delirium in Colorectal Cancer Following Surgery

Sun¹,

Peng²,

Wu³

2023

CIA

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Background: Postoperative delirium (POD) is a common complication in operative patients. Neuroinflammation has been reported to be a potential mechanism associated with the development of POD. Identifying available inflammatory markers such as C-reactive protein (CRP) would aid clinicians in early detection of POD. Previous studies have demonstrated that CRP may be a promising predictive marker for POD. Thus, this study aimed to explore the association between CRP and POD among those elderly colorectal cancer (CRC) patients. Methods: 643 patients with CRC were included in this study. CRP levels were measured before operation and on postoperative day 1. The univariate and multivariate regression analyses were used to identify risk factors for POD. Results: Of 643 patients with CRC, 112 cases (17.4%) had POD. CRC patients with POD showed older age, higher CRP level on postoperative day 1, and higher percentage of smoking, diabetes mellitus, and chronic obstructive pulmonary disease (COPD) than CRC patients without POD. Preoperative CRP level was not associated with the POD. Univariate and multivariate regression analyses showed that older age (> 70 years), diabetes mellitus, COPD, and higher CRP level on postoperative day 1 (> 48 mg/L) were risk factors for POD in CRC patients. Conclusion:Postoperative CRP level is an independent indicator for POD among CRC patients, suggesting the predictive role of postoperative CRP levels for POD in elderly CRC patients undergoing surgery.

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Postoperative delirium and its relationship with biomarkers for dementia: a meta-analysis

Cited by 18 publications

References 58 publications

The effect of parecoxib sodium on postoperative delirium in elderly patients with hip arthroplasty

The effect of parecoxib sodium on postoperative delirium in elderly patients with hip arthroplasty

Automated machine learning‐based model for the prediction of delirium in patients after surgery for degenerative spinal disease

Postoperative C-Reactive Protein Predicts Postoperative Delirium in Colorectal Cancer Following Surgery

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