Original Article

Journal of Anesthesia

, Volume 27, Issue 2, pp 236-242

First online:

Changes in plasma and cerebrospinal fluid biomarkers in aged patients with early postoperative cognitive dysfunction following total hip-replacement surgery

  • Mu-Huo JiAffiliated withDepartment of Anesthesiology, Jinling Hospital, School of Medicine, Nanjing University
  • , Hong-Mei YuanAffiliated withDepartment of Anesthesiology, Nanjing Maternity and Child Health Care Hospital, Nanjing Medical University
  • , Guang-Fen ZhangAffiliated withDepartment of Anesthesiology, Jinling Hospital, School of Medicine, Nanjing University
  • , Xiao-Min LiAffiliated withDepartment of Anesthesiology, Jinling Hospital, School of Medicine, Nanjing University
  • , Lin DongAffiliated withDepartment of Anesthesiology, Jinling Hospital, School of Medicine, Nanjing University
  • , Wei-Yan LiAffiliated withDepartment of Anesthesiology, Jinling Hospital, School of Medicine, Nanjing University
  • , Zhi-Qiang ZhouAffiliated withDepartment of Anesthesiology, Jinling Hospital, School of Medicine, Nanjing University
  • , Jian-Jun YangAffiliated withDepartment of Anesthesiology, Jinling Hospital, School of Medicine, Nanjing University Email author 

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Abstract

Purpose

We hypothesized that different patterns of biomarkers of brain injury and inflammation exist in aged patients with postoperative cognitive dysfunction (POCD) after total hip-replacement with spinal anesthesia.

Methods

Eighty-three patients older than 65 years undergoing elective total hip-replacement surgery were enrolled in this prospective observational study. The CSF levels of Tau, phosphorylated-tau (pTau), amyloidβ1–42 (Aβ1–42), Tau/Aβ1–42, pTau/Aβ1–42, BDNF, IL-6, and IL-1β were measured preoperatively. Perioperative plasma levels of IL-1β, IL-6, brain-derived neurotrophic factor (BDNF), C-reactive protein (CRP), and malonaldehyde (MDA) as well as neurocognitive tests were determined preoperatively and seven days postoperatively.

Results

Sixty-one patients completed both the CSF and blood samples collection and the neurocognitive tests. POCD occurred in 24.6 % of patients at seven days after surgery. Patients with POCD had significantly higher IL-1β, Tau/Aβ1–42, pTau/Aβ1–42, and a lower level of Aβ1–42 in CSF when compared with the Non-POCD group (P < 0.05). Furthermore, POCD patients displayed significantly higher plasma levels of MDA when compared with Non-POCD patients at seven days after surgery (P < 0.05). There was no difference in preoperative CSF levels of Tau, IL-6, and pTau as well as plasma levels of IL-1β, IL-6, BDNF and CRP between POCD and Non-POCD groups (P > 0.05).

Conclusion

The POCD patients were associated with higher postoperative plasma levels of MDA, and higher IL-1β and lower Aβ1–42 levels in preoperative CSF that might predispose the development of POCD in aged patients following total hip-replacement surgery with spinal anesthesia.

Keywords

Postoperative cognitive dysfunction Biomarker Spinal anesthesia Cerebrospinal fluid Plasma