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The effect of permissive hypercapnia on delirium after laparoscopic radical resection of colorectal cancer in elderly patients: a randomized controlled trial

ABSTRACT: Interventions: N:Maintain PaCO2 at 35-45mmHg ;H:Maintain PaCO2 at 45-55mmHg ;P:Maintain PaCO2 at 55-65mmHg Primary outcome(s): Postoperative delirium;IL-1 beta, IL-6, TNF-alpha Study Design: Quasi-randomized controlled

DISEASE(S): Colorectal Cancer

PROVIDER: 2700726 | ecrin-mdr-crc |

REPOSITORIES: ECRIN MDR

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Project description:Delirium is a common postoperative complication among older patients with many adverse outcomes. Due to lack of validated biomarkers, prediction and monitoring of delirium by biological testing is not currently feasible. Circulating proteins in cerebrospinal fluid (CSF) may reflect biological processes causing delirium. Our goal was to discover and investigate candidate protein biomarkers in preoperative CSF that were associated with development of postoperative delirium in older surgical patients. We employed a nested case–control study design coupled with high multiplex affinity proteomics analysis to measure 1305 proteins in preoperative CSF. Twenty-four matched delirium cases and non-delirium controls were selected from the Healthier Postoperative Recovery (HiPOR) cohort and the associations between preoperative protein levels and postoperative delirium were assessed using t-test statistics with further analysis by systems biology to elucidate delirium pathophysiology. Proteomics analysis identified 32 proteins in preoperative CSF that significantly associate with delirium (t-test p<0.05). Due to the limited sample size these proteins did not remain significant by multiple hypothesis testing using the Benjamini-Hochberg correction and q-value method. Three algorithms were applied to separate delirium cases from non-delirium controls. Hierarchical clustering classified 40/48 case-control samples correctly, principal components analysis separated 43/48. The receiver operating characteristic curve yielded an area under the curve [95% confidence interval] of 0.91 [0.80-0.97]. Systems biology analysis identified several key pathways associated with risk of delirium: inflammation, immune cell migration, apoptosis, angiogenesis, synaptic depression and neuronal cell death. Proteomics analysis of preoperative CSF identifies 32 proteins that might discriminate individuals who subsequently develop postoperative delirium from matched control samples. These proteins are potential candidate biomarkers for delirium and may play a role in its pathophysiology.

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The effect of permissive hypercapnia on delirium after laparoscopic radical resection of colorectal cancer in elderly patients: a randomized controlled trial

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