Cerebrospinal Fluid Spermidine, Glutamine and Putrescine Predict Postoperative Delirium Following Elective Orthopaedic Surgery.

ABSTRACT: Delirium is a marker of brain vulnerability, associated with increasing age, pre-existing cognitive impairment and, recently, cerebrospinal fluid (CSF) biomarkers of Alzheimer's disease. This nested case-control study used a targeted quantitative metabolomic methodology to profile the preoperative CSF of patients (n?=?54) who developed delirium following arthroplasty (n?=?28) and those who did not (n?=?26). The aim was to identify novel preoperative markers of delirium, and to assess potential correlations with clinical data. Participants without a diagnosis of dementia (?65 years) undergoing elective primary hip or knee arthroplasty were postoperatively assessed for delirium once-daily for three days. Groups were compared using multivariate, univariate and receiving operator characteristic (ROC) methods. Multivariate modelling using Orthogonal Partial Least Squares-Discriminant Analysis (OPLS-DA) of metabolomic data readily distinguished between delirium and control groups (R2???0.56; Q2???0.10). Three metabolites (spermidine, putrescine and glutamine) significantly differed between groups (P??0.75). The biomarker performance of the two polyamines (spermidine/putrescine) was enhanced by ratio with CSF A?42 (ROC?>?0.8), and spermidine significantly correlated with A?42 (pearson r?=?-0.32; P?=?0.018). These findings suggest that spermidine and putrescine levels could be useful markers of postoperative delirium risk, particularly when combined with A?42, and this requires further investigation.

SUBMITTER: Pan X 

PROVIDER: S-EPMC6414730 | biostudies-literature | 2019 Mar

REPOSITORIES: biostudies-literature