Abstract
Postoperative cognitive dysfunction (POCD) is a common postoperative complication observed in elderly patients. However, the diagnosis of POCD is not very satisfactory as no specific biomarkers have been classified. It is necessary to identify new diagnostic markers to better understand the pathogenesis of POCD. We performed liquid chromatography with a time-of-flight mass spectrometer- (LC/Q-TOF-MS-) based metabolomics study to investigate POCD. A total of 40 metabolites were differentially expressed between POCD and non-POCD patients. In this study, we investigated whether phosphatidylserine (PS) (17:2/0:0), with an area under the curve value of 0.966, was a potential sensitive and specific biomarker for the diagnosis and prognosis of POCD. Pathway analysis showed that fatty acid metabolism, lipid metabolism, and carnitine metabolism were significantly altered in POCD. Network analysis indicated that nitric oxide signaling, PI3K-AKT signaling, mTOR signaling, and mitochondrial dysfunction were related to the pathogenesis of POCD. This study showed that metabolic profiling was meaningful when studying the diagnosis and pathogenesis of POCD.
Highlights
Surgical patients frequently experience postoperative cognitive dysfunction (POCD), which has the symptoms of obstacles of memory, concentration, and language comprehension
While the specific mechanism of POCD is not clear, the best hypothesis regarding the pathogenesis of POCD is that it is caused by central cholinergic deficiencies, which are caused by increased regulation of inflammation by cholinergic anti-inflammatory pathways [1]
There were no significant differences in age, gender ratio, and education levels between the non-POCD group and the POCD group
Summary
Surgical patients frequently experience postoperative cognitive dysfunction (POCD), which has the symptoms of obstacles of memory, concentration, and language comprehension. These symptoms occur seven days after surgery in 25.8% of patients, and 9.9% of patients exhibit these symptoms three months after surgery; in some cases, these symptoms may be permanent. POCD often causes delayed postoperative recovery, prolonged hospital stays, and increased medical costs. The inflammatory response to a surgical procedure was a potential factor involved in the pathogenesis of POCD. Glumac et al found that dexamethasone could significantly reduce the inflammatory response and thereby decreased the risk of early POCD after cardiac surgery when patients were treated with dexamethasone before the surgery [2]. It is urgent to find new biomarkers to better diagnose POCD and new therapeutic targets and drugs to treat POCD, reducing the increasing incidence and diseaserelated burden
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