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Postoperative delirium and its relationship with biomarkers for dementia: a meta-analysis

Published online by Cambridge University Press:  17 January 2022

Sophia Wang Open the ORCID record for Sophia Wang [Opens in a new window] ,
Ryan Greene ,
Yiqing Song ,
Carol Chan ,
Heidi Lindroth ,
Sikandar Khan ,
Gabriel Rios ,
Robert D. Sanders  and
Babar Khan
Sophia Wang*
Affiliation:
Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA Indiana Alzheimer’s Disease Research Center, Indiana University School of Medicine, Indianapolis, IN, USA
Ryan Greene
Affiliation:
Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
Yiqing Song
Affiliation:
Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA
Carol Chan
Affiliation:
Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
Heidi Lindroth
Affiliation:
Division of Nursing Research, Department of Nursing, Mayo Clinic, Rochester, MN, USA
Sikandar Khan
Affiliation:
Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA IU Center of Aging Research, Regenstrief Institute, Indianapolis, IN, USA Center for Health Innovation and Implementation Science, Indiana University School of Medicine, Indianapolis, IN, USA
Gabriel Rios
Affiliation:
Ruth Lilly Medical Library, Indiana University School of Medicine, Indianapolis, IN, USA
Robert D. Sanders
Affiliation:
Specialty of Anaesthetics, University of Sydney, Sydney Medical School/Central Clinical School, Sydney, NSW, Australia Department of Anaesthetics and Institute of Academic Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, USA
Babar Khan
Affiliation:
Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA IU Center of Aging Research, Regenstrief Institute, Indianapolis, IN, USA Center for Health Innovation and Implementation Science, Indiana University School of Medicine, Indianapolis, IN, USA
*
Correspondence should be addressed to: Sophia Wang, Department of Psychiatry, Indiana University School of Medicine, 355 W 16th Street, Suite 4800 GH, Room 4250, Indianapolis, IN 46202, USA. Email: sophwang@iupui.edu
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Abstract

Objectives

This study seeks to identify Alzheimer’s and related dementias (ADRD) biomarkers associated with postoperative delirium (POD) via meta-analysis.

Design:

A comprehensive search was conducted. Studies met the following inclusion criteria: >18 years of age, identified POD with standardized assessment, and biomarker measured in the AT(N)-X (A = amyloid, T = tau, (N)=neurodegeneration, X-Other) framework. Exclusion criteria: focus on prediction of delirium, delirium superimposed on dementia, other neurologic or psychiatric disorders, or terminal delirium. Reviewers extracted and synthesized data for the meta-analysis.

Setting:

Meta-analysis.

Participants:

Patients with POD.

Measurements:

Primary outcome: association between POD and ATN-X biomarkers. Secondary outcomes involved sample heterogeneity.

Results

28 studies were included in this meta-analysis. Studies focused on inflammatory and neuronal injury biomarkers; there were an insufficient number of studies for amyloid and tau biomarker analysis. Two inflammatory biomarkers (IL-6, and CRP) showed a significant relationship with POD (IL-6 n = 10, standardized mean difference (SMD): 0.53, 95% CI: 0.36–0.70; CRP n = 14, SMD: 0.53, 95% CI: 0.33–0.74). Two neuronal injury biomarkers (blood-based S100B and NfL) were positively associated with POD (S100B n = 5, SMD: 0.40, 95% CI: 0.11–0.69; NFL n = 2, SMD: 0.93, 95% CI: 0.28–1.57). Of note, many analyses were impacted by significant study heterogeneity.

Conclusions

This meta-analysis identified an association between certain inflammatory and neuronal injury biomarkers and POD. Future studies will need to corroborate these relationships and include amyloid and tau biomarkers in order to better understand the relationship between POD and ADRD.

Keywords

deliriumpostoperative deliriumAlzheimer’s diseasebiomarkersinflammation
Type
Original Research Article
Information
International Psychogeriatrics , Volume 34 , Issue 4: Issue Theme: Varied Facets of Dementia , April 2022 , pp. 377 - 390
Copyright
© International Psychogeriatric Association 2022

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Footnotes

Sophia Wang and Ryan Greene contributed equally to this work.

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