Postoperative serum thioredoxin concentrations correlate with delirium and cognitive dysfunction after hip fracture surgery in elderly patients

Wu, Xiaomin; Xu, Weicai; Yu, Yong-jian; Han, Liang; Zhang, Jun; Yang, Ling

doi:10.1016/j.cca.2017.01.009

Cited by 16 publications

(11 citation statements)

References 42 publications

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“…32 In our consideration, the surgical stress response and neurological function alterations might be possible explanations for the impacts of these factors on POD. Similar to some other previous reports, 33,34 our results showed that an advanced age predicted POD. Increased age has been well established as an independent risk factor for POD as well as postoperative cognitive dysfunction (POCD).…”

Section: Discussionsupporting

confidence: 92%

Preoperative prognostic nutritional index predicts postoperative delirium in elderly patients after hip fracture surgery

Xing

Xiao

et al. 2020

Psychogeriatrics

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Background Postoperative delirium (POD) is a very common complication in elderly patients after hip fracture surgery, which has poorly understood pathophysiology. This study aimed to investigate potential risk factors for POD. Methods Elderly patients (aged ≥65 years) scheduled to undergo selective surgery in our hospital were consecutively recruited. Patient characteristics, preoperative laboratory tests and prognostic nutritional index (PNI) levels were compared between patients with or without POD. The risk factors for POD were evaluated by univariate and multivariate logistic regression analyses. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive value of PNI and age for POD. Results Fifty‐seven of the 163 enrolled patient had suffered POD within postoperative day 7 with an incidence of 35.0%. Multivariate logistic analyses revealed that an advanced age (cut‐off value: 71.5 years, sensitivity: 48.1%, specificity: 75.4%, odds ratio (OR): 3.24, 95% CI: 1.16–8.69, P = 0.026) and lower PNI level (cut‐off value: 47.45, sensitivity: 86.0%, specificity: 51.9%, OR: 2.88, 95% CI: 1.25–6.64, P = 0.012) were two independent predictive factors associated with POD. According to the ROC curve analysis, preoperative PNI level was a predictor for POD with an area under the curve of 0.686 (95% CI: 0.604–0.767, P < 0.001). Conclusions Advanced age and lower preoperative PNI level were significantly associated with POD in elderly patients after hip fracture surgery.

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Section: Discussionsupporting

confidence: 92%

Preoperative prognostic nutritional index predicts postoperative delirium in elderly patients after hip fracture surgery

Xing

Xiao

et al. 2020

Psychogeriatrics

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“…Data from this study identified comorbidity, with an OR of 1.2, as a strong risk factor for postoperative delirium. Recent studies have revealed similar findings with respect to the relationship between comorbidity and delirium, further supporting our findings (Mosk et al, 2017;Neerland et al, 2017;Wu et al, 2017).…”

Section: Discussionsupporting

confidence: 92%

Incidence and risk factors for acute delirium in older patients with a hip fracture: A retrospective cohort study

Aldwikat

Manias²,

Nicholson

2020

Nursing & Health Sciences

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This retrospective cohort study aimed to determine the incidence, and preoperative, intraoperative, and postoperative risk factors for postoperative delirium in older patients undergoing surgical fixation of a hip fracture. Electronic medical records were examined of 260 patients who underwent a surgical fixation of a hip fracture between June 2017 and October 2018 at a university-affiliated tertiary care hospital in Victoria, Australia. Demographic, clinical, and perioperative data were examined for potential risk factors for postoperative delirium. Of the 260 patients, 63 patients (24.2%) developed delirium postoperatively. Univariate logistic regression analysis indicated that advanced age, comorbidity, cognitive impairment, dementia, American Society of Anesthesiologists score, and antipsychotic usage were significant risk factors for delirium, while doses of paracetamol, fentanyl, and diazepam showed complex associations. Multivariate logistic regression analysis determined comorbidity and cognitive impairment as independent risk factors for the development of delirium. This study demonstrates the importance of evaluation of medications prescribed in the perioperative period as modifiable risk factors, in order to identify patients at high risk of delirium and enable targeted monitoring and treatment during patients' hospitalization.

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“…Twenty-four studies reported data from surgical patients [23–46], of which two studies analyzed the same patient cohort [29, 30]. Of these 24 studies, 12 reported data collected from delirium high-risk surgical cohorts: Two studies reported data from cardiac surgery [39, 42], and ten reported data from hip surgery patients [23, 24, 28, 32, 33, 35–37, 41, 45]. Five studies reported data from medical patients (1026 patients) [47–51], and three studies reported data from a mixed cohort (i.e., surgical and medical patients or not defined; 1086 patients) [52–54].…”

Section: Resultsmentioning

confidence: 99%

“…Leptin levels were significantly lower in patients with delirium compared to those without [36]. Finally, AZGP1 [29], MMP-9 [44], neopterin [42], phenylalanine–tyrosine ratio [42], SERPINA3 [29], thioredoxin [37], and 8-iso-prostaglandin F2α [38] were linked to postoperative delirium.…”

Section: Resultsmentioning

confidence: 99%

Serum biomarkers of delirium in the elderly: a narrative review

Toft

Tontsch

Abdelhamid

et al. 2019

Ann. Intensive Care

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Delirium after surgery and in the intensive care unit (ICU) remains a challenge for patients, families, and caregivers. Over the years, many promising biomarkers have been investigated as potential instruments for risk stratification of delirium. This review aimed to identify and assess the clinical usefulness of candidate serum biomarkers associated with hospital delirium in patients aged 60 years and older. We performed a time-unlimited review of publications indexed in PubMed, Cochrane, Embase, and MEDLINE databases until June 2019 that evaluated baseline and/or longitudinal biomarker measurements in patients suffering from delirium at some point during their hospital stay. A total of 32 studies were included in this review reporting information on 7610 patients. Of these 32 studies, twentyfour studies reported data from surgical patients including four studies in ICU cohorts, five studies reported data from medical patients (1026 patients), and three studies reported data from a mixed cohort (1086 patients), including one study in an ICU cohort. Findings confirm restricted clinical usefulness to predict or diagnose delirium due to limited evidence on which biomarkers can be used and limited availability due to non-routine use.

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Postoperative serum thioredoxin concentrations correlate with delirium and cognitive dysfunction after hip fracture surgery in elderly patients

Cited by 16 publications

References 42 publications

Preoperative prognostic nutritional index predicts postoperative delirium in elderly patients after hip fracture surgery

Preoperative prognostic nutritional index predicts postoperative delirium in elderly patients after hip fracture surgery

Incidence and risk factors for acute delirium in older patients with a hip fracture: A retrospective cohort study

Serum biomarkers of delirium in the elderly: a narrative review

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