Role of Dyslipidemia in Postoperative Delirium
Research Article
DOI:
https://doi.org/10.5281/zenodo.7977521Keywords:
Postoperative Delirium, Triglycerides, Low-Density LipoproteinAbstract
Introduction: Postoperative delirium (POD) is a condition characterized by an acute decline in cognitive function and attention, often seen in older adults.
Objective: This study aims to investigate the relationship between preoperative lipid levels and the development of postoperative delirium.
Method: This retrospective study included 41 patients who developed delirium after knee and hip operations in our hospital. Delirium was diagnosed by psychiatrists using the 'Confusion Rating Scale' questionnaire. Demographic characteristics, comorbidities, blood biochemistry and lipid levels were investigated.
Results: The mean age of patients who developed POD was 68.63±7.59 years and 61% were female. Total cholesterol (TC), triglyceride (TG), low density lipoprotein (LDL), non-high density lipoprotein (HDL) levels and TG/HDL, LDL/HDL ratios were significantly higher in patients who developed postoperative delirium than in the control group (p<0.05). C-Reactive Protein (CRP) and ferritin levels were significantly higher in the group with postoperative delirium than in the control group (p<0.001, p= 0.003).
Conclusion: In conclusion, we found that preoperative TC, TG, LDL and non-HDL levels and new lipid-related biomarkers TG/HDL and LDL/HDL ratios were significantly higher in patients with POD compared to the control group. Lipid levels should be taken into consideration in the evaluation of the risk of postoperative delirium in patients and necessary precautions should be taken to improve the prognosis.
References
Inouye SK, Westendorp RGJ, Saczynski JS. Delirium in elderly people. Lancet. 2014: 8; 383(9920): 911–922. https://doi.org/10.1016/S0140-6736(13)60688-1
American Psychiatric Association. Task force on DSM-IV, diagnostic and statistical manual of mental disorders: DSM-IV (text revision) 4. Washington, DC: The Association; 2000. https://doi.org/10.1176/appi.books.9780890423349
Marcantonio ER. Postoperative delirium: a 76-year-old woman with delirium following surgery. JAMA. 2012; 308: 73–81. https://doi.org/10.1001/jama.2012.6857
Gleason LJ, Schmitt EM, Kosar CM, et al. Effect of delirium and other major complications on outcomes after elective surgery in older adults. JAMA Surg. 2015;150:1134–40. https://doi.org/10.1001/jamasurg.2015.2606
Witlox J, Eurelings LS, Jonghe JF, et al. Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia: a meta-analysis. JAMA. 2010;304:443–51. https://doi.org/10.1001/jama.2010.1013
Jong L, Rijckevorsel V, Raats JW, et al. Delirium after hip hemiarthroplasty for proximal femoral fractures in elderly patients: risk factors and clinical outcomes. Clin Interv Aging 2019;14:427–35. https://doi.org/10.2147/CIA.S189760
Pandharipande PP, Girard TD, Jackson JC, et al. Long-term cognitive impairment after critical illness. N Engl J Med. 2013;369:1306–16. https://doi.org/10.1056/NEJMoa1301372
Zhang X, Tong DK, Ji F, et al.. Predictive nomogram for postoperative delirium in elderly patients with a hip fracture. Injury 2019;50:392–7. https://doi.org/10.1016/j.injury.2018.10.034
Ahmed S, Leurent B, Sampson EL. Risk factors for incident delirium among older people in acute hospital medical units: a systematic review and meta-analysis. Age Ageing. 2014;43:326–333. https://doi.org/10.1093/ageing/afu022
Fong TG, Vasunilashorn SM, Gou Y, et al. Association of CSF Alzheimer’s disease biomarkers with postoperative delirium in older adults. Alzheimers Dement. 2021; 7: e12125. https://doi.org/10.1002/trc2.12125
Oliveira J, Engel DF, Paula GC, et al. High cholesterol diet exacerbates blood-brain barrier disruption in LDLr-/- mice: impact on cognitive function.J. Alzheimers Dis. 2020; 78: 97-115. https://doi.org/10.3233/JAD-200541
Gamba P, Testa G, Sottero B,et al.The link between altered cholesterol metabolism and Alzheimer’s disease.Ann. N Y Acad. Sci. 2012; 1259: 54-64. https://doi.org/10.1111/j.1749-6632.2012.06513.x
Outen K, Akintade BF. Implementation of the Confusion Assessment Method for Noncritically Ill Adult Patients.Crit Care Nurs Clin North Am. 2019; 31(4): 475-480. https://doi.org/10.1016/j.cnc.2019.07.002
Vasilevskis EE, Chandrasekhar R, Holtze CH, et al. The Cost of ICU Delirium and Coma in the Intensive Care Unit Patient. Med Care. 2018; 56(10): 890-897. https://doi.org/10.1097/MLR.0000000000000975
Aldecoa C, Bettelli G, Bilotta F, et al. European Society of Anaesthesiology evidence-based and consensus-based guideline on postoperative delirium. EurJAnaesthesiol. 2017;34:192–214. https://doi.org/10.1097/EJA.0000000000000594
Huang X, Li L, Feng Q. Correlation Analysis of Inflammatory Markers CRP and IL-6 and Postoperative Delirium (POD) in Elderly Patients: A Meta-Analysis of Observational Studies. J Environ Public Health. 2022; 2022: 1136386. https://doi.org/ 10.1155/2022/1136386
Zhang Z , PanL, Deng H , Ni H , Xu X. Prediction of delirium in critically ill patients with elevated C-reactive protein. 2014; 29: 88-92. https://doi.org/10.1016/j.jcrc.2013.09.00210.1016/j.jcrc.2013.09.002
Mahroum N,Alghory A, Kiyak Z,et al. Ferritin – from iron, through inflammation and autoimmunity, to COVID-19. J Autoimmun. 2022; 126: 102778. https://doi.org/10.1016/j.jaut.2021.102778
Liu Q, Zerbinatti CV, Zhang J, et al. Amyloid Precursor Protein Regulates Brain Apolipoprotein E and Cholesterol Metabolism through Lipoprotein Receptor LRP1. Neuron 2007; 56: 66-78. https://doi.org/10.1016/j.neuron.2007.08.008
Davis DHJ, Muniz-Terrera G, Keage HAD, et al. Association of Delirium With Cognitive Decline in Late Life. JAMA Psychiatry. 2017; 74(3): 244. https://doi.org/10.1001/jamapsychiatry.2016.3423
Lin Y, Peng X, Lin X, et al. Potential Value of Serum Lipid in the Identication of Postoperative Delirium Undergoing Knee/Hip Arthroplasty: The Perioperative Neurocognitive Disorder and Biomarker Lifestyle Study.Front Psychiatry. 2022; 13: 870317. https://doi.org/10.3389/fpsyt.2022.870317
Wei L, Sun J, Xie H, et.al. Interaction Analysis of Abnormal Lipid Indices and Hypertension for Ischemic Stroke: A 10-Year Prospective Cohort Study.Front Cardiovasc Med. 2022; 9: 819274. https://doi.org/10.3389/fcvm.2022.819274
Kosmas CE, Polanco SR , Bousvarou MD, et al. The Triglyceride/High-Density Lipoprotein Cholesterol (TG/HDL-C) Ratio as a Risk Marker for Metabolic Syndrome and Cardiovascular Disease. Diagnostics (Basel) 2023; 13(5): 929. https://doi.org/ 10.3390/diagnostics13050929
Pillai JA, Bena J, BekrisL, et al. Metabolic syndrome biomarkers relate to rate of cognitive decline in MCI and dementia stages of Alzheimer's disease. Alzheimers Res Ther. 2023; 15(1): 54. https://doi.org/10.1186/s13195-023-01203-y
Zaciragic A, Dervisevic A, Valjevac A, et al. Difference in the Standard and Novel Lipid Profile Parameters Between Patients With Alzheimer’s Disease and Vascular Dementia Stratified by the Degree of Cognitive Impairment. Mater Sociomed. 2022; 34(2): 100–106. https://doi.org/10.5455/msm.2022.34.100-106
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Acta Medica Ruha
This work is licensed under a Creative Commons Attribution 4.0 International License.