TY - JOUR
T1 - Association of perioperative plasma concentration of neurofilament light with delirium after cardiac surgery
T2 - a nested observational study
AU - Brown, Charles H.
AU - Kim, Alexander S.
AU - Yanek, Lisa
AU - Lewis, Alexandria
AU - Mandal, Kaushik
AU - Le, Lan
AU - Tian, Jing
AU - Neufeld, Karin J.
AU - Hogue, Charles
AU - Moghekar, Abhay
N1 - Publisher Copyright:
© 2023 British Journal of Anaesthesia
PY - 2024/2
Y1 - 2024/2
N2 - Background: Neurofilament light is a blood-based biomarker of neuroaxonal injury that can provide insight into perioperative brain vulnerability and injury. Prior studies have suggested that increased baseline and postoperative concentrations of neurofilament light are associated with delirium after noncardiac surgery, but results are inconsistent. Results have not been reported in cardiac surgery patients, who are among those at highest risk for delirium. We hypothesised that perioperative blood concentrations of neurofilament light (both baseline and change from baseline to postoperative day 1) are associated with delirium after cardiac surgery. Methods: This study was nested in a trial of arterial blood pressure targeting during cardiopulmonary bypass using cerebral autoregulation metrics. Blood concentrations of neurofilament light were measured at baseline and on postoperative day 1. The primary outcome was postoperative delirium. Regression models were used to examine the associations between neurofilament light concentration and delirium and delirium severity, adjusting for age, sex, race, logistic European System for Cardiac Operative Risk Evaluation, bypass duration, and cognition. Results: Delirium occurred in 44.6% of 175 patients. Baseline neurofilament light concentration was higher in delirious than in non-delirious patients (median 20.7 pg ml−1 [IQR 16.1–33.2] vs median 15.5 pg ml−1 [IQR 12.1–24.2], P<0.001). In adjusted models, greater baseline neurofilament light concentration was associated with delirium (odds ratio, 1.027; 95% confidence interval, 1.003–1.053; P=0.029) and delirium severity. From baseline to postoperative day 1, neurofilament light concentration increased by 42%, but there was no association with delirium. Conclusions: Baseline neurofilament light concentration, but not change from baseline to postoperative day 1, was associated with delirium after cardiac surgery.
AB - Background: Neurofilament light is a blood-based biomarker of neuroaxonal injury that can provide insight into perioperative brain vulnerability and injury. Prior studies have suggested that increased baseline and postoperative concentrations of neurofilament light are associated with delirium after noncardiac surgery, but results are inconsistent. Results have not been reported in cardiac surgery patients, who are among those at highest risk for delirium. We hypothesised that perioperative blood concentrations of neurofilament light (both baseline and change from baseline to postoperative day 1) are associated with delirium after cardiac surgery. Methods: This study was nested in a trial of arterial blood pressure targeting during cardiopulmonary bypass using cerebral autoregulation metrics. Blood concentrations of neurofilament light were measured at baseline and on postoperative day 1. The primary outcome was postoperative delirium. Regression models were used to examine the associations between neurofilament light concentration and delirium and delirium severity, adjusting for age, sex, race, logistic European System for Cardiac Operative Risk Evaluation, bypass duration, and cognition. Results: Delirium occurred in 44.6% of 175 patients. Baseline neurofilament light concentration was higher in delirious than in non-delirious patients (median 20.7 pg ml−1 [IQR 16.1–33.2] vs median 15.5 pg ml−1 [IQR 12.1–24.2], P<0.001). In adjusted models, greater baseline neurofilament light concentration was associated with delirium (odds ratio, 1.027; 95% confidence interval, 1.003–1.053; P=0.029) and delirium severity. From baseline to postoperative day 1, neurofilament light concentration increased by 42%, but there was no association with delirium. Conclusions: Baseline neurofilament light concentration, but not change from baseline to postoperative day 1, was associated with delirium after cardiac surgery.
KW - blood biomarker
KW - cardiac surgery
KW - geriatrics
KW - neurofilament light
KW - postoperative delirium
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U2 - 10.1016/j.bja.2023.10.043
DO - 10.1016/j.bja.2023.10.043
M3 - Article
C2 - 38114355
AN - SCOPUS:85180321284
SN - 0007-0912
VL - 132
SP - 312
EP - 319
JO - British journal of anaesthesia
JF - British journal of anaesthesia
IS - 2
ER -