Schaefer Simon T, Koenigsperger Stephan, Olotu Cynthia, Saller Thomas
Department of Anaesthesiology, University Hospital, LMU Munich, Munich.
Department of Anaesthesiology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
Curr Opin Anaesthesiol. 2019 Feb;32(1):92-100. doi: 10.1097/ACO.0000000000000676.
Neurocognitive dysfunction after surgery is highly relevant in the elderly. The multifactorial manner of this syndrome has made it hard to define an ideal biomarker to predict individual risk and assess diagnosis and severity of delirium [postoperative delirium (POD)] and subsequent postoperative cognitive decline (POCD). This review summarizes recent literature on blood biomarkers for POD/POCD.
Markers for delirium have been searched for in the cerebrospinal fluid to examine the pathologic cascade. However, cerebrospinal fluid cannot be easily obtained in the perioperative setting. Thus, attention shifts toward prediction markers from patients' blood to determine the individual risk. In this regard, three major groups of peripheral blood markers could be distinguished: first, global, but unspecific markers associated with POD/POCD; second, specific and established markers related to neurocognitive function; and third, upcoming or newly described markers with less evidence. Solely neuron-specific enolase is an adequate biomarker based on recent literature.
Single markers for postoperative cognitive impairment cannot predict POD/POCD in geriatric patients. However, a wisely arranged battery of promising biomarkers might achieve a satisfying sensitivity and specificity for the preoperative assessment of subsequent cognitive decline. Adequately powered studies to prove this hypothesis are required.
术后神经认知功能障碍在老年人中极为常见。该综合征的多因素性质使得难以确定一种理想的生物标志物来预测个体风险以及评估谵妄[术后谵妄（POD）]和随后的术后认知功能下降（POCD）的诊断和严重程度。本综述总结了近期关于POD/POCD血液生物标志物的文献。
人们一直在脑脊液中寻找谵妄的标志物以研究病理级联反应。然而，在围手术期不易获取脑脊液。因此，注意力转向从患者血液中寻找预测标志物以确定个体风险。在这方面，可以区分出三大类外周血标志物：第一，与POD/POCD相关的全身性但非特异性标志物；第二，与神经认知功能相关的特异性且已确定的标志物；第三，证据较少的新兴或新描述的标志物。根据近期文献，仅神经元特异性烯醇化酶是一种合适的生物标志物。
术后认知功能障碍的单一标志物无法预测老年患者的POD/POCD。然而，一组精心安排的有前景的生物标志物可能会在术前评估后续认知功能下降方面实现令人满意的敏感性和特异性。需要进行有足够效力的研究来证实这一假设。
