Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
Department of Anaesthesiology and Intensive Care Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
BMC Neurol. 2024 Mar 1;24(1):80. doi: 10.1186/s12883-024-03580-9.
Postoperative delirium is a frequent and severe complication after cardiac surgery. Activity of butyrylcholinesterase (BChE) has been discussed controversially regarding a possible role in its development. This study aimed to investigate the relevance of BChE activity as a biomarker for postoperative delirium after cardiac surgery or percutaneous valve replacement.
A total of 237 patients who received elective cardiothoracic surgery or percutaneous valve replacement at a tertiary care centre were admitted preoperatively. These patients were tested with the Montreal Cognitive Assessment investigating cognitive deficits, and assessed for postoperative delirium twice daily for three days via the 3D-CAM or the CAM-ICU, depending on their level of consciousness. BChE activity was measured at three defined time points before and after surgery.
Postoperative delirium occurred in 39.7% of patients (n = 94). Univariate analysis showed an association of pre- and postoperative BChE activity with its occurrence (p = 0.037, p = 0.001). There was no association of postoperative delirium and the decline in BChE activity (pre- to postoperative, p = 0.327). Multivariable analysis including either preoperative or postoperative BChE activity as well as age, MoCA, type 2 diabetes mellitus, coronary heart disease, type of surgery and intraoperative administration of red-cell concentrates was performed. Neither preoperative nor postoperative BChE activity was independently associated with the occurrence of postoperative delirium (p = 0.086, p = 0.484). Preoperative BChE activity was lower in older patients (B = -12.38 (95% CI: -21.94 to -2.83), p = 0.011), and in those with a history of stroke (B = -516.173 (95% CI: -893.927 to -138.420), p = 0.008) or alcohol abuse (B = -451.47 (95% CI: -868.38 to -34.55), p = 0.034). Lower postoperative BChE activity was independently associated with longer procedures (B = -461.90 (95% CI: -166.34 to -757.46), p = 0.002), use of cardiopulmonary bypass (B = -262.04 (95% CI: -485.68 to -38.39), p = 0.022), the number of administered red cell-concentrates (B = -40.99 (95% CI: -67.86 to -14.12), p = 0.003) and older age (B = -9.35 (95% CI: -16.04 to -2.66), p = 0.006).
BChE activity is not independently associated with the occurrence of postoperative delirium. Preoperative BChE values are related to patients' morbidity and vulnerability, while postoperative activities reflect the severity, length and complications of surgery.
术后谵妄是心脏手术后常见且严重的并发症。丁酰胆碱酯酶（BChE）的活性被认为与其发病机制有关。本研究旨在探讨 BChE 活性作为心脏手术后或经皮瓣膜置换术后发生术后谵妄的生物标志物的相关性。
共有 237 名在三级护理中心接受择期心胸手术或经皮瓣膜置换术的患者在术前接受了检查。这些患者接受了蒙特利尔认知评估（MoCA）测试，以检查认知缺陷，并在术后 3 天内每天两次通过 3D-CAM 或 CAM-ICU 进行评估，具体取决于他们的意识水平。在手术前后三个特定时间点测量了 BChE 活性。
39.7%（n=94）的患者发生了术后谵妄。单变量分析显示，术前和术后 BChE 活性与术后谵妄的发生相关（p=0.037，p=0.001）。术后 BChE 活性下降与术后谵妄之间没有相关性（术前至术后，p=0.327）。进行了包括术前或术后 BChE 活性以及年龄、MoCA、2 型糖尿病、冠心病、手术类型和术中输注红细胞浓缩物的多变量分析。术前或术后 BChE 活性均与术后谵妄的发生无关（p=0.086，p=0.484）。老年患者（B=-12.38（95%CI：-21.94 至-2.83），p=0.011）和有卒中史（B=-516.173（95%CI：-893.927 至-138.420），p=0.008）或酒精滥用史（B=-451.47（95%CI：-868.38 至-34.55），p=0.034）的患者术前 BChE 活性较低。术后 BChE 活性降低与手术时间较长（B=-461.90（95%CI：-166.34 至-757.46），p=0.002）、使用体外循环（B=-262.04（95%CI：-485.68 至-38.39），p=0.022）、输注红细胞浓缩物的数量（B=-40.99（95%CI：-67.86 至-14.12），p=0.003）和年龄较大（B=-9.35（95%CI：-16.04 至-2.66），p=0.006）独立相关。
BChE 活性与术后谵妄的发生无独立相关性。术前 BChE 值与患者的发病率和脆弱性有关，而术后活性则反映了手术的严重程度、持续时间和并发症。
