<p>The relationship between serum cobalamin, folic acid, and homocysteine and the risk of post-cardiac surgery delirium</p>

Abstract

Purpose: It has been reported that cobalamin and folate deficiency is related to delirium in persons with dementia. We evaluated the association of admission serum levels of cobalamin, folic acid, and homocysteine with the occurrence of acute delirium after coronary artery bypass surgery. Methods: In this prospective cohort study, serum levels of cobalamin, folic acid, and homocysteine were measured for 296 patients upon admission. Delirium was defined by the confusion assessment method for the intensive care unit. Results: Postoperative delirium was detected in 23% (n=68) of patients. Cobalamin deficiency, folate deficiency, and hyperhomocysteinemia were observed in 29% (n=86), 6% (n=18), and 68% (n=200) of patients, respectively. The mean ± SD serum levels of folic acid were 10.77±5.39 ng/mL and 12.86±6.51 ng/mL in delirium and non-delirium patients, respectively ( P =0.008). The median (interquartile range [IQR]) serum levels of cobalamin were 280 (216–351) and 247 (195.5–336) in delirium and non-delirium patients, respectively ( P =0.09). The median (IQR) serum levels of homocysteine were 18.5 (14.5–22.1) µmol/L and 17.33 (14.2–23.2) µmol/L in delirium and non-delirium patients, respectively ( P =0.94). Multivariate regression analysis adjusted by other risk factors indicated that serum homocysteine, folate, and cobalamin levels had no association with the occurrence of delirium. Conclusion: There was no relationship between the preoperative levels of cobalamin, folate, and homocysteine, and acute occurrence of delirium observed after cardiac surgery.

Preoperative homocysteine modifies the association between postoperative C-reactive protein and postoperative delirium

“…Preoperative plasma homocysteine is associated with postoperative delirium in patients after cancer surgery ( Weerink et al, 2018 ) or hemiarthroplasty ( Guo et al, 2020 ). However, another study showed no association between preoperative plasma homocysteine and the incidence of postoperative delirium in patients with cardiac surgery ( Vahdat Shariatpanahi et al, 2019 ). Here, we showed that participants with postoperative delirium had higher median preoperative plasma concentrations of homocysteine than participants without postoperative delirium after hip or knee surgery.…”

“…Hyperhomocysteine (elevated plasma homocysteine concentration) is a potential predisposing factor owing to its involvement in cardiovascular disease ( Refsum et al, 1998 ) and AD ( Morris, 2003 ). Preoperative plasma hyperhomocysteine concentration is associated with postoperative delirium ( Kim et al, 2015 ; Weerink et al, 2018 ), but conflicting results exist ( Vahdat Shariatpanahi et al, 2019 ; Guo et al, 2020 ). Moreover, hyperhomocysteine increases blood-brain barrier (BBB) permeability ( Kamath et al, 2006 ; Beard et al, 2011 ) and promotes neuroinflammation, which can lead to cognitive dysfunction ( Adamis et al, 2009 ; Varatharaj and Galea, 2017 ).…”

“…Preoperative homocysteine and postoperative CRP were evaluated in this study because postoperative CRP is an established blood biomarker of postoperative delirium ( Dillon et al, 2017 ; Vasunilashorn et al, 2017 ; Slor et al, 2019 ). However, the role of preoperative homocysteine in postoperative delirium has not been fully revealed ( Kim et al, 2015 ; Weerink et al, 2018 ; Vahdat Shariatpanahi et al, 2019 ; Guo et al, 2020 ). Moreover, we chose homocysteine and CRP, but not other inflammatory factors, e.g., S100β and interleukin 6, in the present study because we aimed to use preoperative homocysteine and postoperative CRP to specifically investigate the effects of interaction between the predisposing factor (preoperative homocysteine) and the precipitating factor (postoperative CRP) on the postoperative delirium.…”

Cobalamin Deficiency in the Elderly

“…Severe CblD in the elderly may predispose to delirium, 45 , 50 , 51 although this association has been confuted by a recent report. 52 …”

“…Severe CblD in the elderly may predispose to delirium, 45,50,51 although this association has been confuted by a recent report. 52 Of note, recent trials do not support Cbl supplementation in the elderly with normal to low Cbl levels for preventing cognitive deterioration. 53,54 Other Manifestations.…”