Di Lichao, Huang Peiying, He Yeju, Li Jie, Liu Yu, Chi Liwei, Sun Na, Huang Lining
Department of Anesthesiology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
Department of Medical Imaging, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
Aging Clin Exp Res. 2025 Aug 29;37(1):258. doi: 10.1007/s40520-025-03140-2.
Postoperative delirium (POD) is a frequent and serious complication in older adults after cardiac surgery. Blood-brain barrier (BBB) dysfunction is implicated in cognitive decline, but its preoperative role in POD remains underexplored. This pilot study aimed to investigate the association between preoperative regional BBB permeability, assessed by dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), and POD in older patients undergoing off-pump coronary artery bypass grafting (OPCABG).
This prospective observational pilot study, registered in the Chinese Clinical Trial Registry (ChiCTR2200063774), included patients aged ≥ 65 years scheduled for OPCABG. Preoperative BBB permeability (quantified as Ktrans) in the hippocampus, thalamus, frontal lobe, and temporal lobe, along with regional brain volumes and Montreal Cognitive Assessment-Basic (MoCA-B) scores, were assessed. POD was diagnosed using the 3-Minute Diagnostic Confusion Assessment Method (3D-CAM) or CAM-ICU for 5 postoperative days. Univariable and multivariable logistic regression analyses were performed to identify predictors of POD. Correlations between Ktrans, volume, and POD severity (CAM-S) were examined.
Fifty patients (mean age 69.0 ± 3.3 years) were analyzed; 19 (38%) developed POD. In univariable analysis, higher preoperative Ktrans in the hippocampus (Odds Ratio [OR] 1.350, 95%CI 1.048-1.740, P = 0.020) and thalamus (OR 1.466, 95%CI 1.017-2.113, P = 0.040), lower MoCA-B scores (P = 0.020), and smaller hippocampal (OR 0.297, 95%CI 0.131-0.672, P = 0.004) and thalamic volumes (OR 0.304, 95%CI 0.121-0.766, P = 0.012) were associated with POD. However, in multivariable logistic regression including MoCA-B, Ktrans, and volumes, only lower MoCA-B scores (OR 0.697, 95%CI 0.513-0.947, P = 0.021) and smaller hippocampal volume (OR 0.322, 95%CI 0.105-0.992, P = 0.048) remained independent predictors of POD incidence. Preoperative hippocampal Ktrans correlated significantly with POD severity (CAM-S, r = 0.673, P = 0.002).
In this pilot study, while increased preoperative BBB permeability in the hippocampus and thalamus was associated with POD univariably, baseline cognitive function and hippocampal volume were stronger independent preoperative predictors of POD incidence after OPCABG. Higher preoperative hippocampal BBB permeability was associated with greater POD severity, suggesting a role for pre-existing BBB vulnerability in exacerbating delirium. These preliminary and exploratory findings warrant validation in larger, adequately powered cohorts and highlight the complex interplay of pre-existing brain vulnerabilities in POD development.
Chinese Clinical Trial Registry (ChiCTR2200063774; registered on 09/16/2022).
术后谵妄（POD）是老年患者心脏手术后常见且严重的并发症。血脑屏障（BBB）功能障碍与认知功能下降有关，但其术前在POD中的作用仍未得到充分研究。这项前瞻性观察性试点研究旨在调查术前通过动态对比增强磁共振成像（DCE-MRI）评估的局部BBB通透性与接受非体外循环冠状动脉搭桥术（OPCABG）的老年患者POD之间的关联。
这项前瞻性观察性试点研究已在中国临床试验注册中心（ChiCTR2200063774）注册，纳入计划接受OPCABG的年龄≥65岁的患者。评估术前海马体、丘脑、额叶和颞叶的BBB通透性（量化为Ktrans），以及局部脑容量和蒙特利尔认知评估基础版（MoCA-B）评分。术后5天使用3分钟诊断性谵妄评估方法（3D-CAM）或CAM-ICU诊断POD。进行单变量和多变量逻辑回归分析以确定POD的预测因素。检查Ktrans、体积与POD严重程度（CAM-S）之间的相关性。
分析了50例患者（平均年龄69.0±3.3岁）；19例（38%）发生POD。在单变量分析中，术前海马体（优势比[OR]1.350，95%置信区间1.048-1.740，P = 0.020）和丘脑（OR 1.466，95%置信区间1.017-2.113，P = 0.040）的Ktrans较高、MoCA-B评分较低（P = 0.020）以及海马体（OR 0.297，95%置信区间0.131-0.672，P = 0.004）和丘脑体积较小（OR 0.304，95%置信区间0.121-0.766，P = 0.012）与POD相关。然而，在包括MoCA-B、Ktrans和体积的多变量逻辑回归中，只有较低的MoCA-B评分（OR 0.697，95%置信区间0.513-0.947，P = 0.021）和较小的海马体体积（OR 0.322，95%置信区间0.105-0.992，P = 0.048）仍然是POD发生率的独立预测因素。术前海马体Ktrans与POD严重程度（CAM-S，r = 0.673，P = 0.002）显著相关。
在这项试点研究中，虽然术前海马体和丘脑的BBB通透性增加与POD单变量相关，但基线认知功能和海马体体积是OPCABG术后POD发生率更强的术前独立预测因素。术前较高的海马体BBB通透性与更大的POD严重程度相关，表明预先存在的BBB脆弱性在加重谵妄方面的作用。这些初步和探索性发现需要在更大、样本量充足的队列中进行验证，并突出了预先存在的脑脆弱性在POD发生发展中的复杂相互作用。
中国临床试验注册中心（ChiCTR2200063774；于2022年9月16日注册）。
