Serum Biomarkers of a Pro-Neuroinflammatory State May Define the Pre-Operative Risk for Postoperative Delirium in Spine Surgery

Advances in spine surgery enable technically safe interventions in older patients with disabling spine disease, yet postoperative delirium (POD) poses a serious risk for postoperative recovery. This study investigates biomarkers of pro-neuroinflammatory states that may help objectively define the pre-operative risk for POD. This study enrolled patients aged & GE;60 scheduled for elective spine surgery under general anesthesia. Biomarkers for a pro-neuroinflammatory state included S100 calcium-binding protein & beta; (S100 & beta;), brain-derived neurotrophic factor (BDNF), Gasdermin D, and the soluble ectodomain of the triggering receptor expressed on myeloid cells 2 (sTREM2). Postoperative changes of Interleukin-6 (IL-6), Interleukin-1 & beta; (IL-1 & beta;), and C-reactive protein (CRP) were assessed as markers of systemic inflammation preoperatively, intraoperatively, and early postoperatively (up to 48 h). Patients with POD (n = 19, 75.7 & PLUSMN; 5.8 years) had higher pre-operative levels of sTREM2 (128.2 & PLUSMN; 69.4 pg/mL vs. 97.2 & PLUSMN; 52.0 pg/mL, p = 0.049) and Gasdermin D (2.9 & PLUSMN; 1.6 pg/mL vs. 2.1 & PLUSMN; 1.4 pg/mL, p = 0.29) than those without POD (n = 25, 75.6 & PLUSMN; 5.1 years). STREM2 was additionally a predictor for POD (OR = 1.01/(pg/mL) [1.00-1.03], p = 0.05), moderated by IL-6 (Wald-& chi;(2) = 4.06, p = 0.04). Patients with POD additionally showed a significant increase in IL-6, IL-1 & beta;, and S100 & beta; levels on the first postoperative day. This study identified higher levels of sTREM2 and Gasdermin D as potential markers of a pro-neuroinflammatory state that predisposes to the development of POD. Future studies should confirm these results in a larger cohort and determine their potential as an objective biomarker to inform delirium prevention strategies.

Automated summary

Advances in spine surgery allow for safe interventions in older patients, but postoperative delirium (POD) remains a major concern. This study investigates biomarkers that may help identify the pre-operative risk for POD, and finds higher levels of sTREM2 and Gasdermin D as potential markers for POD.