Preoperative Status of Gut Microbiota Predicts Postoperative Delirium in Patients With Gastric Cancer

Abstract

IntroductionPost-operative delirium (POD) is a serious complication which occurs after surgery, especially in the elderly undergoing abdominal surgery. Increasing evidence has revealed an association between the gut microbiota and psychological disorders involving the “brain-gut” axis. However, the association between the pathogenesis of POD after abdominal surgery in aging and composition of the gut microbiota remains unclear.MethodsForty patients (≥65 years old) who underwent abdominal surgery were included in the study. Twenty patients had POD, whereas 20 patients did not. POD was diagnosed and assessed using the confusion assessment method (CAM) during the postoperative period. Total DNA fractions were extracted from all fecal samples of patients. 16S rRNA sequencing was performed to determine the composition of the gut microbiota. The quality of the samples was determined by calculating the α- and β-diversities.ResultsThe α- and β-diversities indicated that the samples were eligible for detection and comparison. We observed multiple differentially abundant bacteria in patients with and without POD. Generally, Proteobacteria, Enterbacteriaceae, Escherichia shigella, Klebsiella, Ruminococcus, Roseburia, Blautia, Holdemanella, Anaerostipes, Burkholderiaceae, Peptococcus, Lactobacillus, and Dorea were abundant in the POD cohort, whereas Streptococcus equinus and Blautia hominis were abundant in the control cohort. The results of receiver operating characteristic (ROC) curve analysis showed that the area under the curve (AUC) of Escherichia shigella was 0.75. Phenotype prediction showed that the gut microbiota may influence POD by altering the tolerance to oxidative stress.ConclusionThere were significant associations between the pathogenesis of POD and composition of the gut microbiota. Escherichia shigella are promising diagnostic bacterial species for predicting POD onset after abdominal surgery in elderly people.Clinical Trial Registrationhttp://www.chictr.org.cn/index.aspx, Chinese Clinical Trial Registry ChiCTR200030131.

The association between gut microbiota and postoperative delirium in patients

“…Previous studies have shown that patients who developed postoperative delirium (N = 20) and did not develop postoperative delirium (N = 20) had a different abundance of preoperative gut bacteria 52 . Speci cally, gut bacteria Proteobacteria, Enterobacteriaceae, Escherichia shigella, Klebsiella, Ruminococcus, Roseburia, Blautia, Holdemanella, Anaerostipes, Burkholderiaceae, Peptococcus, Lactobacillus, and Dorea were abundant in the patients with postoperative delirium, and Streptococcus equinus and Blautia hominis were abundant in the patients without postoperative delirium 52 . However, this previous study is different from the current study, as it determined preoperative, not postoperative, gut microbiota; did not establish an association with the incidence of postoperative delirium; and did not assess the severity of delirium with the MDAS.…”

The association between gut microbiota and postoperative delirium in patients

“…Previous studies have shown that patients who developed postoperative delirium ( N = 20) and who did not develop postoperative delirium ( N = 20) had a different abundance of preoperative gut bacteria [ 44 ]. Specifically, gut bacteria Proteobacteria, Enterobacteriaceae, Escherichia shigella, Klebsiella, Ruminococcus, Roseburia, Blautia, Holdemanella, Anaerostipes, Burkholderiaceae, Peptococcus, Lactobacillus , and Dorea were abundant in the patients with postoperative delirium, and Streptococcus equinus and Blautia hominis were abundant in the patients without postoperative delirium [ 44 ]. However, this previous study is different from the current study, as it determined preoperative, not postoperative, gut microbiota, did not establish an association with the incidence of postoperative delirium, and did not assess the severity of delirium with the MDAS.…”

Postoperative Delirium in Neurosurgical Patients: Recent Insights into the Pathogenesis

“…Altered β diversity and intestinal microbiota richness, as well as decreased levels of TJ proteins (ZO-1 and occludin), have been detected in the intestinal tract of mice with surgery-induced cognitive dysfunction [ 121 ]. Differential abundances of specific gut microbiota were detected between patients with and without POD after abdominal surgery, with a positive association between the phenotype of oxidative-stress-tolerant bacteria and POD [ 122 ]. A novel study suggested that oxidative stress and mitochondrial damage in microglia driven by the gut microbiota are probably the results of the metabolite N6-carboxymethyllysine [ 123 ].…”