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. 2022 Mar;113(3):1000-1007.
doi: 10.1016/j.athoracsur.2021.03.035. Epub 2021 Mar 25.

Serum Biomarkers in Postoperative Delirium After Esophagectomy

Sikandar H Khan  1 , Heidi Lindroth  2 , Yameena Jawed  3 , Sophia Wang  4 , Jason Nasser  5 , Sarah Seyffert  6 , Kiran Naqvi  7 , Anthony J Perkins  8 , Sujuan Gao  8 , Kenneth Kesler  9 , Babar Khan  10
Affiliations

Serum Biomarkers in Postoperative Delirium After Esophagectomy

Sikandar H Khan et al. Ann Thorac Surg. 2022 Mar.

Abstract

Background: Esophagectomy is associated with postoperative delirium, but its pathophysiology is not well defined. We conducted this study to measure the relationship among serum biomarkers of inflammation and neuronal injury and delirium incidence and severity in a cohort of esophagectomy patients.

Methods: Blood samples were obtained from patients preoperatively and on postoperative days 1 and 3 and were analyzed for S100 calcium-binding protein B, C-reactive protein (CRP), interleukin (IL) 8 and IL-10, tumor necrosis factor-α, and insulin-like growth factor 1. Delirium was assessed twice daily using the Richmond Agitation Sedation Scale and Confusion Assessment Method for Intensive Care Unit. Delirium severity was assessed once daily with the Delirium Rating Scale-Revised-98.

Results: Samples from 71 patients were included. Preoperative biomarker concentrations were not associated with postoperative delirium. Significant differences in change in concentrations from preoperatively to postoperative day 1 were seen in IL-8 (delirium, 38.6; interquartile range [IQR], 29.3-69.8; no delirium, 24.8; IQR, 16.0-41.7, P = .022), and IL-10 (delirium, 26.1; IQR, 13.9-36.7; no delirium, 12.4; IQR, 7.7-25.7; P = .025). Greater postoperative increase in S100 calcium-binding protein B (Spearman r = 0.289, P = .020) and lower levels of insulin-like growth factor 1 were correlated with greater delirium severity (Spearman r = -0.27, P = .040). Greater CRP change quartiles were associated with higher delirium incidence adjusting for severity of illness (odds ratio, 1.68; 95% confidence interval, 1.03-2.75; P = .037) or comorbidities (odds ratio, 1.70; 95% confidence interval, 1.05-2.76, P = .030).

Conclusions: Differences in change in serum CRP, IL-8, and IL-10 concentrations were associated with postoperative delirium, suggesting biomarker measurement early in the postoperative course is associated with delirium.

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Figures

Figure 1.
Figure 1.. Change in median biomarker concentrations from preoperative to postoperative day 1 by delirium status
IL-8 p=0.022, IL-10 p=0.025, p>0.05 for all other biomarkers. CRP: C-Reactive Protein; IGF: Insulin-like growth factor; IL: Interleukin; POD: Postoperative day; S100B: S100 Calcium Binding Protein B. TNFA: Tumor necrosis factor alpha.
Figure 2.
Figure 2.. Percentage of patients with delirum by quartiles of change in biomarker values from preoperative to postoperative day 1.
CRP: C-Reactive Protein; IGF: Insulin-like growth factor; IL: Interleukin; POD: Postoperative day; S100B: S100 Calcium Binding Protein B. TNFA: Tumor necrosis factor alpha.
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