Department of Anesthesiology and Pain Relief Center, The University of Tokyo Hospital, Tokyo, Japan.
Department of Pain and Palliative Medical Sciences, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
Sci Rep. 2022 Oct 12;12(1):17091. doi: 10.1038/s41598-022-21682-7.
Older adult surgical patients are susceptible to developing delirium. Early intervention can be initiated if a potential biomarker associated with delirium can be identified during the acute phase of surgery. Therefore, we investigated the changes in the levels of serum inflammatory mediators responsible for delirium. Serum biomarkers were measured preoperatively to postoperative day 3 in 96 patients who underwent esophageal cancer surgery and compared between patients who did and did not develop delirium. Serum concentrations of the brain-derived phosphorylated neurofilament heavy subunit remained at higher levels throughout the entire perioperative period in patients with delirium (n = 15) than in those without delirium (n = 81). The interaction between delirium and non-delirium was significant for plasminogen activator inhibitor-1 (including age as a covariate, F = 13.360, p < 0.0001, η = 0.134, observed power 1.000) during the perioperative periods. Plasminogen activator inhibitor-1 level discriminated between patients with and without clinically diagnosed delirium with significantly high accuracy (area under curve, 0.864; sensitivity, 1.00: negative predictive value, 1.000; p = 0.002). Rapid increases in the levels of serum plasminogen activator inhibitor-1 may enable clinicians to identify patients at risk of developing postoperative delirium and initiate early prevention and intervention.
老年外科患者易发生谵妄。如果能在手术急性期识别出与谵妄相关的潜在生物标志物，就可以早期进行干预。因此，我们研究了与谵妄有关的血清炎症介质水平的变化。我们在 96 例行食管癌手术的患者中检测了术前至术后第 3 天的血清生物标志物，并比较了发生和未发生谵妄的患者之间的差异。与未发生谵妄的患者（n=81）相比，发生谵妄的患者（n=15）的血清脑源性磷酸化神经丝重亚单位（phosphorylated neurofilament heavy subunit，pNF-H）水平在整个围手术期都保持在较高水平。在围手术期，谵妄与非谵妄之间的交互作用对纤溶酶原激活物抑制剂-1（plasminogen activator inhibitor-1，PAI-1）有显著影响（包括年龄作为协变量，F=13.360，p<0.0001，η 2=0.134，观察效能 1.000）。纤溶酶原激活物抑制剂-1水平对临床诊断为谵妄的患者和无谵妄的患者有较高的鉴别准确性（曲线下面积，0.864；灵敏度，1.00：阴性预测值，1.000；p=0.002）。血清纤溶酶原激活物抑制剂-1水平的快速升高可能使临床医生能够识别发生术后谵妄的高风险患者，并尽早进行预防和干预。
