Correlation of Serum BACE1 With Emergence Delirium in Postoperative Patients: A Preliminary Study

Abstract

Background: The mechanism underlying delirium, a common acute fluctuating mental state, may be related to the activation of a neuroinflammatory response. In this study, we attempted to investigate whether plasma inflammatory response markers, vascular and cerebrovascular injury-related markers, and neurodegeneration-associated markers were associated with emergence delirium (ED). Methods: Patients aged 50 years or above who underwent elective laparoscopic surgery under general anesthesia were included in this study. Delirium was assessed postoperatively with the Richmond Agitation Sedation Scale (RASS) and the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) scale. Plasma samples were collected from ED patients and non-ED patients to test concentrations of inflammation markers, including interleukin 6 (IL-6), chitinase 3-like 1 (CHI3L1), S100 calciumbinding protein B (S100B), lipoprotein-associated phospholipase-A2 (Lp-PLA2), and macrophage migration inhibitory factor (MIF); vascular and cerebrovascular injury-related markers, including intercellular cell adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule (VCAM-1); and neurodegeneration-associated markers, including alpha-synuclein (α-Syn) and β-secretase 1 (BACE1). Binary logistic regression analysis was performed to analyze the relationship between biomarkers and ED, and receiver operating characteristic (ROC) curves were used to analyze the diagnostic value of biomarkers. Results: A total of 104 patients were included in this study, with an average age of 63.69 ± 7.21. IL-6 (OR = 2.73, 95% CI: 1.66-6.44, P = 0.022), S100B (OR = 4.74, 95% CI: 1.88-11.95, P = 0.001), and BACE1 (OR = 6.54, 95% CI: 2.57-16.65, P < 0.000) were independent biological indicators for the occurrence of ED.CHI3L1, Lp-PLA2, MIF, ICAM-1, VCAM-1, and α-Syn were unrelated to ED. Plasma BACE1 level had a possible diagnostic value for ED [area under curve (AUC) = 0.75, 95% CI: 0.66-0.85], whereas plasma IL-6 (AUC = 0.62, 95% CI: 0.51-0.73) and S100B (AUC = 0.65, 95% CI: 0.54-0.76) levels had little diagnostic value for distinguishing ED vs. non-ED. Conclusion: Higher levels of systemic inflammation marker IL-6, cerebral inflammation marker S100B, and neurodegeneration-associated marker BACE1 are related to ED. Plasma BACE1 may be a potential diagnostic biomarker for ED.

Intraoperative body temperature and emergence delirium in elderly patients after non-cardiac surgery: a secondary analysis of a prospective observational study

“…CAM-ICU has been used in several studies to assess ED. [ 3 , 13 , 19 , 20 ] Taking the criteria of delirium in the Diagnostic and Statistical Manual of Mental Disorders 4th edition as a standard reference, the specificity of CAM-ICU to diagnose ED in PACU is about 98% (95% CI 88–100%). [ 21 ] This indicates that a positive CAM-ICU do represent true ED.…”

Alpha-Synuclein in Peripheral Tissues as a Possible Marker for Neurological Diseases and Other Medical Conditions

“…In 104 patients undergoing elective laparoscopic surgery, serum aSyn levels were not associated with the development of postoperative emergence delirium [ 94 ].…”

Exploring the Pathophysiology of Delirium: An Overview of Biomarker Studies, Animal Models, and Tissue-Engineered Models

“…59 Elevated IL-6 and C-reactive protein (CRP) are 2 other proinflammatory factors that have been highly associated with delirium in various cohorts. [38][39][40][41][42][43][44][60][61][62][63] An upregulation in the complement pathway in patients with delirium has also been identified based on RNA-seq analysis of peripheral blood mononuclear cells isolated from whole blood samples. 64 inflammation has been purported to be a major driver of neuroinflammation characterized by activation of microglial and astrocytes in the CNS leading to neuronal dysfunction and loss of network integration.…”