Journal
BRITISH JOURNAL OF ANAESTHESIA
Volume 116, Issue 1, Pages 83-89Publisher
ELSEVIER SCI LTD
DOI: 10.1093/bja/aev415
Keywords
brain injury biomarkers; non-cardiac surgery; postoperative cognitive dysfunction
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Funding
- Anesthesia Patient Safety Foundation
- National Institutes of Health [R01 092259]
- Japan Heart Foundation/Bayer Yakuhin Research Grant Abroad
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Background: Postoperative cognitive dysfunction (POCD) is common after non-cardiac surgery, but the mechanism is unclear. We hypothesized that decrements in cognition 1 month after non-cardiac surgery would be associated with evidence of brain injury detected by elevation of plasma concentrations of S100 beta, neuron-specific enolase (NSE), and/or the brain-specific protein glial fibrillary acid protein (GFAP). Methods: One hundred and forty-nine patients undergoing shoulder surgery underwent neuropsychological testing before and then 1 month after surgery. Plasma was collected before and after anaesthesia. We determined the relationship between plasma biomarker concentrations and individual neuropsychological test results and a composite cognitive functioning score (mean Z-score). Results: POCD (>=-1.5 SD decrement in Z-score from baseline) was present in 10.1% of patients 1 month after surgery. There was a negative relationship between higher plasma GFAP concentrations and lower postoperative composite Z-scores {estimated slope=-0.14 [95% confidence interval (CI) -0.24 to -0.04], P=0.005} and change from baseline in postoperative scores on the Rey Complex Figure Test copy trial (P=0.021), delayed recall trial (P=0.010), and the Symbol Digit Modalities Test (P=0.004) after adjustment for age, sex, history of hypertension and diabetes. A similar relationship was not observed with S100 beta or NSE concentrations. Conclusions: Decline in cognition 1 month after shoulder surgery is associated with brain cellular injury as demonstrated by elevated plasma GFAP concentrations.
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