| Autor: |
Ruhnau J; Department of Neurology, University Medicine Greifswald, 17475 Greifswald, Germany., Müller J; Department of Neurosurgery, University Medicine Greifswald, 17475 Greifswald, Germany., Nowak S; Department of Neurosurgery, University Medicine Greifswald, 17475 Greifswald, Germany., Strack S; Department of Neurology, University Medicine Greifswald, 17475 Greifswald, Germany., Sperlich D; Department of Neurology, University Medicine Greifswald, 17475 Greifswald, Germany., Pohl A; Department of Neurology, University Medicine Greifswald, 17475 Greifswald, Germany., Dilz J; Department of Neurology, University Medicine Greifswald, 17475 Greifswald, Germany., Saar A; Department of Neurology, University Medicine Greifswald, 17475 Greifswald, Germany., Veser Y; Department of Neurology, University Medicine Greifswald, 17475 Greifswald, Germany., Behr F; Department of Neurology, University Medicine Greifswald, 17475 Greifswald, Germany., Rehberg S; Department of Anesthesiology, Evangelisches Klinikum Bethel, 33617 Bielefeld, Germany., Usichenko T; Department of Anesthesiology, University Medicine Greifswald, 17475 Greifswald, Germany., Hahnenkamp K; Department of Anesthesiology, University Medicine Greifswald, 17475 Greifswald, Germany., Ehler J; Department of Anesthesiology and Intensive Care Medicine, University Hospital Jena, 07743 Jena, Germany., Flöel A; Department of Neurology, University Medicine Greifswald, 17475 Greifswald, Germany.; Center for Neurodegenerative Diseases Rostock/Greifswald, 18147 Rostock, Germany., Schroeder HWS; Department of Neurosurgery, University Medicine Greifswald, 17475 Greifswald, Germany., Müller JU; Department of Neurosurgery, University Medicine Greifswald, 17475 Greifswald, Germany., Fleischmann R; Department of Neurology, University Medicine Greifswald, 17475 Greifswald, Germany., Vogelgesang A; Department of Neurology, University Medicine Greifswald, 17475 Greifswald, Germany. |
| Abstrakt: |
Advances in spine surgery enable technically safe interventions in older patients with disabling spine disease, yet postoperative delirium (POD) poses a serious risk for postoperative recovery. This study investigates biomarkers of pro-neuroinflammatory states that may help objectively define the pre-operative risk for POD. This study enrolled patients aged ≥60 scheduled for elective spine surgery under general anesthesia. Biomarkers for a pro-neuroinflammatory state included S100 calcium-binding protein β (S100β), brain-derived neurotrophic factor (BDNF), Gasdermin D, and the soluble ectodomain of the triggering receptor expressed on myeloid cells 2 (sTREM2). Postoperative changes of Interleukin-6 (IL-6), Interleukin-1β (IL-1β), and C-reactive protein (CRP) were assessed as markers of systemic inflammation preoperatively, intraoperatively, and early postoperatively (up to 48 h). Patients with POD ( n = 19, 75.7 ± 5.8 years) had higher pre-operative levels of sTREM2 (128.2 ± 69.4 pg/mL vs. 97.2 ± 52.0 pg/mL, p = 0.049) and Gasdermin D (2.9 ± 1.6 pg/mL vs. 2.1 ± 1.4 pg/mL, p = 0.29) than those without POD ( n = 25, 75.6 ± 5.1 years). STREM2 was additionally a predictor for POD (OR = 1.01/(pg/mL) [1.00-1.03], p = 0.05), moderated by IL-6 (Wald-χ 2 = 4.06, p = 0.04). Patients with POD additionally showed a significant increase in IL-6, IL-1β, and S100β levels on the first postoperative day. This study identified higher levels of sTREM2 and Gasdermin D as potential markers of a pro-neuroinflammatory state that predisposes to the development of POD. Future studies should confirm these results in a larger cohort and determine their potential as an objective biomarker to inform delirium prevention strategies. |
