Department of Old Age Psychiatry and Psychotic Disorders, Medical University of Lodz, Lodz, Poland.
Central Clinical Hospital, Medical University of Lodz, Lodz, Poland.
Ann Med. 2022 Dec;54(1):610-616. doi: 10.1080/07853890.2022.2039405.
Though risk factors of postoperative delirium are well described, its pathophysiology is still undiscovered. The primary objective of the current study is to assess whether increased pre- and postoperative myeloperoxidase (MPO) levels are associated with postoperative delirium in the population of cardiac surgery patients. The secondary objective is to evaluate the correlation between MPO levels and serum antioxidant capacity (AC).
The patients' cognitive status was assessed one day preoperatively with the use of the Mini-Mental State Examination Test and the Clock Drawing Test. A diagnosis of major depressive disorder and anxiety disorders was established based on DSM-5 criteria. Blood samples for MPO and AC levels were collected both pre- and postoperatively. The Confusion Assessment Method for the Intensive Care Unit was used to screen for a diagnosis of delirium.
Delirium occurred in 34% (61 of 177) of patients. Multivariable logistic regression analysis revealed that increased postoperative MPO concentration was independently associated with postoperative delirium development, and negatively correlated with lower baseline serum AC.
Cardiac surgery patients with less efficient antioxidative mechanisms experience a higher postoperative peak of serum MPO, which in turn may predispose to postoperative delirium development.KEY MESSAGESMPO is a lysosomal enzyme with strong pro-oxidative and pro-inflammatory properties.Cardiac surgery patients who have increased concentration of postoperative MPO are at significantly higher risk of postoperative delirium development.This higher level of postoperative MPO is negatively correlated with baseline antioxidant capacity (AC).It can be hypothesized that individuals with decreased baseline AC experience a higher peak of MPO post-surgery due to less efficient antioxidative mechanisms, which in turn contributes to postoperative delirium development.
尽管术后谵妄的风险因素已有详细描述，但其病理生理学仍未被发现。本研究的主要目的是评估心脏手术患者人群中术前和术后髓过氧化物酶（MPO）水平升高是否与术后谵妄有关。次要目的是评估 MPO 水平与血清抗氧化能力（AC）之间的相关性。
使用简易精神状态检查和时钟绘制测试，在术前一天评估患者的认知状态。根据 DSM-5 标准，确定主要抑郁障碍和焦虑障碍的诊断。分别在术前和术后采集 MPO 和 AC 水平的血液样本。使用 ICU 意识模糊评估方法筛查谵妄诊断。
34%（177 例中的 61 例）的患者发生了谵妄。多变量逻辑回归分析显示，术后 MPO 浓度增加与术后谵妄的发生独立相关，与较低的基线血清 AC 呈负相关。
抗氧化机制效率较低的心脏手术患者术后血清 MPO 峰值较高，这反过来可能导致术后谵妄的发生。
MPO 是一种溶酶体酶，具有很强的促氧化和促炎特性。
术后 MPO 浓度增加的心脏手术患者发生术后谵妄的风险显著增加。
术后 MPO 水平升高与基线抗氧化能力（AC）呈负相关。
可以假设，由于抗氧化机制效率降低，基线 AC 降低的个体在手术后经历更高的 MPO 峰值，这反过来又导致术后谵妄的发生。
