Preoperative Serum Metabolites and Potential Biomarkers for Perioperative Cognitive Decline in Elderly Patients.

Wenbin Lu,Jie Huang,Xiya Yu,Zhengyu Jiang,Jinjun Bian

doi:10.3389/fpsyt.2021.665097

Wenbin Lu, Jie Huang + Show 3 more

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https://doi.org/10.3389/fpsyt.2021.665097

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Abstract

Perioperative cognitive decline is one of the perioperative neurocognitive disorders common to see in elderly patients. Although POCD increases patient mortality and hospitalization time, the exact inflammatory and related mechanisms are still unknown. Besides, the diagnosis of POCD lacks a unified and straightforward evaluation neuropsychological scale. Metabolites could reveal chemical fingerprints left behind by the cellular process, which provides a new aspect to understand the biological process behind. According to the post-operative MMSE score, 56 patients who received elective orthopedics surgery were included and divided into POCD and Non-POCD groups. Preoperative serum metabolites in both groups and post-operative serum metabolites were analyzed. We then performed an SVM model using 10 differential metabolites in preoperative samples as features to evaluate the patients' risk of POCD, which appeared to be positively associated with POCD and could be a potential biomarker. We also analyzed differential serum metabolites from preoperative and post-operative samples of POCD patients. By analyzing their overlap differential metabolites with between POCD and Non-POCD patients, we further inferred seven metabolites positively related to the POCD mechanism. Our results provide a more convenient method to aid POCD diagnosis and prevention using biomarkers and explore the possible mechanism behind.

Highlights

Perioperative cognitive dysfunction (POCD) is an overarching term for cognitive impairment identified in the preoperative or post-operative period
No significant difference existed in age, gender, body mass index (BMI), American Society of Anesthesiologists (ASA) score, education level, preoperative MMSE score, operation duration, treatment during surgery, disease history, or other general characteristics between POCD and Non-POCD groups
In order to better understanding how metabolomics varied across time in POCD and Non-POCD groups, we divided them into three groups and named preoperative Non-POCD as Non-POCD pre-op, preoperative POCD group as POCD pre-op, and postoperative POCD group as POCD post-op

Summary

Introduction

Perioperative cognitive dysfunction (POCD) is an overarching term for cognitive impairment identified in the preoperative or post-operative period. This includes cognitive decline diagnosed before operation (described as neurocognitive disorder), any form of the acute event (post-operative delirium), cognitive decline diagnosed up to 30 days after the procedure (delayed neurocognitive recovery), and up to 12 months (post-operative neurocognitive disorder) [1]. POCD refers to disorders affecting orientation, attention, perception, consciousness, and judgment that develop after surgery. Patients over the age of 65 who underwent non-cardiac surgery had a 26% prevalence of POCD within a few weeks, which decreased to 10% 3 months postoperatively [2]. POCD has become a severe medical problem and a social problem that cannot be ignored

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