Department of Anesthesiology and Reanimation, Faculty of Medicine, Yozgat Bozok University, Yozgat, Turkey.
Department of Cardiovascular Surgery, Faculty of Medicine, Yozgat Bozok University, Yozgat, Turkey.
J Clin Anesth. 2021 Aug;71:110235. doi: 10.1016/j.jclinane.2021.110235. Epub 2021 Mar 25.
To determine the prognostic value of the change in intraoperative BDNF (Brain-derived neurotrophic factor) levels during cardiac surgery with cardiopulmonary bypass (CPB) on early perioperative neurocognitive disorder (PND).
Prospective observational pilot study.
The study was performed in the Medical Faculty Hospital, from January 2020 to August 2020.
45 adult patients undergoing elective coronary artery bypass surgery (CABG) with CPB.
None.
Cognitive function was evaluated 1 day before and 4 days after the surgery. Serum BDNF levels were measured at four time points (T1: after induction; T2: with aortic cross-clamp; T3: without aortic cross-clamp; T4: 4 days after surgery) by enzyme-linked immunosorbent assay.
The incidence of PND was 37.8% four days after surgery. Serum BDNF (T2 and T4) levels were significantly lower in PND group compared to non- PND group (p = 0.003 and p = 0.016, respectively). Moreover, lactate, rSO (regional cerebral oxygen saturation), aortic cross-clamp time, CPB duration, and the amount of blood transfusion differed between the groups. Logistic regression analysis identified serum BDNF-T2, age, cross-clamp time, and rSO-T2 as independent risk factors for PND. Based on the ROC analysis, the area under curve (AUC) of BDNF-T2 concentration for prediction of PND was 0.759 with sensitivity of 71.4% and specificity of 64.7% (p < 0.01).
Intraoperative BDNF serum levels may be a useful biomarker in predicting PND in patients undergoing CABG surgery. More comprehensive studies is needed in order to confirm the effect of decreasing intraoperative BDNF serum levels on the development of PND.
NCT04250935 www.clinicaltrials.gov.
确定体外循环（CPB）心脏手术期间 BDNF（脑源性神经营养因子）水平变化对早期围手术期神经认知障碍（PND）的预后价值。
前瞻性观察性试点研究。
该研究在 2020 年 1 月至 2020 年 8 月期间在医学系附属医院进行。
45 名接受体外循环冠状动脉旁路移植术（CABG）的成年患者。
无。
在手术前 1 天和手术后 4 天评估认知功能。通过酶联免疫吸附试验在四个时间点（T1：诱导后；T2：带主动脉夹；T3：不带主动脉夹；T4：手术后 4 天）测量血清 BDNF 水平。
手术后 4 天 PND 的发生率为 37.8%。与非 PND 组相比，PND 组 T2 和 T4 时血清 BDNF 水平显著降低（p=0.003 和 p=0.016）。此外，两组间乳酸、局部脑氧饱和度（rSO）、主动脉夹闭时间、CPB 时间和输血量存在差异。逻辑回归分析确定血清 BDNF-T2、年龄、夹闭时间和 rSO-T2 为 PND 的独立危险因素。基于 ROC 分析，BDNF-T2 浓度预测 PND 的曲线下面积（AUC）为 0.759，灵敏度为 71.4%，特异性为 64.7%（p<0.01）。
体外循环心脏手术期间血清 BDNF 水平可能是预测 CABG 手术患者 PND 的有用生物标志物。需要进行更全面的研究以确认降低术中 BDNF 血清水平对 PND 发展的影响。
NCT04250935 www.clinicaltrials.gov。
