Abstract
BackgroundPost-operative delirium (POD) is a common post-operative complication in elderly individuals and imposes a significant health and financial burden. Identifying predictive biomarkers may help understand the pathophysiology of POD. Our objective is to summarize the evidence of pre-operative biomarkers and imaging tests to predict POD in patients undergoing non-cardiac surgery.MethodsA systematic search of English language articles in MEDLINE, EMBASE, Cochrane Database, PsychINFO, PubMed and ClinicalTrials. Gov up to January 2018 was performed. Studies that used biomarkers or imaging tests to predict POD and a validated POD assessment tool were included. Animal studies, paediatric, cardiac and intracranial surgery were excluded. Risk of bias was assessed using the Quality In Prognosis Study tool.ResultsThirty-four prospective cohort studies involving 4424 patients were included. Nineteen studies described serum tests [Interleukin-6, Insulin-like Growth Factor 1, C-Reactive Protein (CRP), cholinesterases, apolipoprotein-E genotype, leptin, hypovitaminosis, hypoalbuminaemia, gamma-amino butyric acid], 10 described cerebral-spinal fluid tests (monoamine precursor, melatonin, acute phase proteins, S100B and neurofibrillary tangles), and 5 described imaging tests. Two studies had high risk of bias due to unclear outcome measurement and study participation. CRP was significantly associated with POD in 5 studies. Other biomarkers were either examined by only a single study or two or more studies with conflicting results.ConclusionCRP is the most promising biomarker associated with POD. However, we are still in the early stages in identifying biomarkers and imaging tests that may further understanding of the pathophysiology of POD.
Highlights
Post-operative delirium (POD) is a common post-operative complication in elderly individuals and imposes a significant health and financial burden
Delirium is a common problem in hospitalized elderly individuals; it is defined as an acute onset of impaired cognitive functions, disturbance in attention and awareness that is not due to a pre-existing, established, or evolving neurocognitive disorder
In studies which assessed delirium on the day of surgery, none mentioned whether they included post- anaesthesia care unit (PACU) delirium or distinguished between emergence agitation or POD
Summary
Post-operative delirium (POD) is a common post-operative complication in elderly individuals and imposes a significant health and financial burden. Identifying predictive biomarkers may help understand the pathophysiology of POD. Our objective is to summarize the evidence of pre-operative biomarkers and imaging tests to predict POD in patients undergoing non-cardiac surgery. Ayob et al BMC Anesthesiology (2019) 19:25 and patients who experience PACU delirium are reported to have higher risk of POD [3]. There is increasing interest in investigating the pathogenesis of POD as reflected by the high number of studies examining various biomarkers. Investigating possible biomarkers to identify high-risk patients may advance understanding about the pathophysiology of delirium. This systematic review aims to summarize the current evidence with respect to biomarkers and imaging tests that may predict POD in non-cardiac surgery patients
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
