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[Preprint]. 2023 Jan 23:rs.3.rs-2456664.
doi: 10.21203/rs.3.rs-2456664/v1.

The association between gut microbiota and postoperative delirium in patients

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The association between gut microbiota and postoperative delirium in patients

Zhongcong Xie et al. Res Sq. .

Update in

Abstract

Postoperative delirium is one of the most common postoperative complications in older patients. Its pathogenesis and biomarkers, however, remain largely undetermined. Majority of human microbiota is gut microbiota and gut microbiota has been shown to regulate brain function. Therefore, this study aimed to determine the association between gut microbiota and postoperative delirium in patients. Of 220 patients (65 years old or older) who had a knee replacement, hip replacement, or laminectomy under general or spinal anesthesia, 86 participants were included in the data analysis. The incidence (primary outcome) and severity of postoperative delirium was assessed for two days. Fecal swabs were collected from participants immediately after surgery. The 16S rRNA gene sequencing was used to assess gut microbiota. Using principal component analyses along with a literature review to identify biologically plausible mechanisms, and three bacterials were studied for their associations with postoperative delirium. Of the 86 participants [age 71.0 (69.0-76.0, 25%-75% percentile of quartile), 53% female], ten (12%) developed postoperative delirium. Postoperative gut bacteria Parabacteroides distasonis (Odds Ratio [OR] 2.13, 95% Confidence Interval (CI): 1.09-4.17, P = 0.026) was associated with postoperative delirium after adjusting for age and sex. The association between delirium and both Prevotella (OR: 0.59, 95% CI: 0.33-1.04, P = 0.067) and Collinsella (OR: 0.57, 95% CI: 0.27-1.24, P = 0.158) did not meet statistical significance. These findings suggest that postoperative gut microbiota (e.g., Parabacteroides distasonis ) may serve as biomarkers in the pathogenesis of postoperative delirium, pending confirmative studies.

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Figures

Figure 1
Figure 1. Flow Diagram.
The flow diagram shows that 491 participants were screened for the studies, and 220 were initially enrolled. A total of 117 participants were excluded after enrollment, and 103 participants were included in the gut microbiota cohort. During the analysis 17 additional participants were excluded, resulting in 86 participants for the final data analysis.
Figure 2
Figure 2. Different postoperative gut bacteria between participants with and without postoperative delirium.
Participants who developed postoperative delirium (N = 10) had a higher postoperative relative abundance of gut bacteria of Parabacteroides distasonis a lower abundance of postoperative gut bacteria of Prevotella (B), but not Collinsella (Figure 2C), than the participants who did not develop postoperative delirium (N = 76). The box indicates median (50 th percentile), the first quartile (25 th percentile), and the third quartile (75 th percentile) of the abundances of bacteria.

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