Incidence of delirium after non-cardiac surgery in the Chinese elderly population: a systematic review and meta-analysis

Association of reduced cerebrospinal fluid NPTX2 levels with postoperative delirium in patients undergoing knee/hip replacement: a prospective cohort study

BACKGROUND

Postoperative delirium (POD) is a common complication with poor prognosis in the elderly, but its mechanism has not been fully elucidated. There is evidence that the changes in synaptic activity in the brain are closely related to the occurrence of POD. And neuronal pentraxin 2 (NPTX2) can regulate synaptic activity in vivo.

AIMS

This study aims to explore whether decreased NPTX2 levels affects POD and whether the cerebrospinal fluid (CSF) biomarkers of POD mediate this association.

METHODS

In this prospective cohort study, we interviewed patients with knee/hip replacement 1 day before surgery to collect patient information and assess their cognitive function. CSF was extracted for measuring the CSF levels of NPTX2 and other POD biomarkers on the day of surgery. And postoperative follow-up visits were performed 1-7 days after surgery.

RESULTS

Finally, 560 patients were included in the study. The patients were divided into POD group and NPOD (non-POD) group. The POD group had a median age of 80 years, a female proportion of 45%, a median BMI of 24.1 kg/m2, and a median years of education of 9 years. The Mann-Whitney U test showed that CSF NPTX2 levels were significantly lower in POD group, compared with the NPOD group (P < 0.05). Univariate binary logistic regression analysis showed that reduced CSF levels of NPTX2 protected against POD (crude OR = 0.994, 95% CI 0.993-0.995, P < 0.001). The receiver-operating characteristic (ROC) curve indicated that CSF NPTX2 level had high predictive value for POD. Mediation analyses showed that CSF T-tau (mediating proportion = 21%) and P-tau (mediating proportion = 29%) had significant mediating effects on the association between CSF NPTX2 and POD.

CONCLUSION

CSF NPTX2 levels were associated with the occurrence of POD. Low CSF NPTX2 levels may be an independent protective factor for POD. CSF T-tau and P-tau could mediate the association between CSF NPTX2 and POD occurrence.

CLINICAL TRIAL REGISTRATION

The trial registration number (TRN): ChiCTR2200064740, Date of Registration: 2022-10-15.

The Association of Preoperative Trail Making Tests With Postoperative Delirium

Aims The aim of the present study was to investigate the preoperative Trail Making Test (TMT) and its association with postoperative delirium. Materials and methods This cross-sectional, observational study consisted of 51 patients admitted to the surgical ward for any planned operative procedure. Consenting patients provided their sociodemographic information, and the Hospital Anxiety and Depression Scale (HADS), Montreal Cognitive Assessment (MoCA) test, and Trail Making Test (TMT) were applied. Results A total of 51 patients (66.7% male and 33.3% female) were categorized as the "normal" group (n=34), completing TMT in time, and the "slow" group (n=17). The mean age was 45.05 ± 13.69 for the normal group and 44.29 ± 10.95 for the slow group. The HADS score mean was 15.02 ± 9.52 and 11.64 ± 5.73, respectively, for these two groups (t = -1.577; degrees of freedom {df} = 47.11; p = 0.121). However, the "normal" group scored significantly higher MoCA scores in comparison to the slow group (26.35 ± 1.06 and 24.29 ± 1.10, respectively) (t = -6.410; df = 49; p = 0.000). Conclusions The study shows that the TMT can indicate effectively the cognitive decline in preoperative patients, which predicts postoperative delirium.