The relationship between body mass index and postoperative delirium

Deng, Xiyuan; Qin, Pei-Juan; Lin, Yu‐Jr; Tao, He; Liu, Fanghao; Xu, Lin; Wang, Bin; Bi, Yanlin

doi:10.1002/brb3.2534

Cited by 21 publications

(27 citation statements)

References 53 publications

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“…Nevertheless, the present meta-analysis showed no association of other patient characteristics or comorbidities such as gender, BMI, and the prevalence of hypertension with the development of POD. Despite the demonstration of a negative correlation between BMI and the risk of POD in a previous study ( 59 ), we found no such association possibly due to the recruitment of patients without obesity in most of our included studies (i.e., BMI < 25 kg/m 2 in six studies with no detail being given in three studies) ( Table 1 ). Besides, although previous clinical studies showed that prolonged surgical/anesthetic time was a risk factor for POD ( 26 , 60 , 61 ), our findings did not support this relationship.…”

Section: Discussioncontrasting

confidence: 78%

Association of preoperative prognostic nutritional index with risk of postoperative delirium: A systematic review and meta-analysis

Hung

Chiu²,

Hsu³

et al. 2023

Front. Med.

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Study objectiveTo assess the association between prognostic nutritional index (PNI) and risk of postoperative delirium (POD) in adult patients.MethodsMEDLINE, Google scholar, EMBASE, and Cochrane library databases were searched from inception till April 2022. The primary outcome was the association between PNI and the risk of POD, while the secondary outcomes were correlations of other prognostic factors with POD risk. The correlation between PNI and the incidence of POD was assessed with three approaches: Difference in preoperative PNI between POD and non-POD groups (Model 1) as well as the association of PNI as a continuous parameter (Model 2) or as a binary variable (i.e., low vs. high using a PNI cut-off value of 50) (Model 3) with POD risk.ResultsAnalysis of nine observational studies published from 2010 to 2021 recruiting 3,743 patients showed a POD incidence of 6.4–35%. Our meta-analysis demonstrated a lower PNI among patients in the POD group (MD: −3.78, 95% CI: −4.85 to −2.71, p < 0.0001, I2 = 54.2%) compared to the non-POD group (Model 1). Pooled results revealed a negative association between PNI and POD risk for both Model 2 (OR: 0.91, 95% CI: 0.86–0.97, p = 0.002, I2 = 71%) and Model 3 (OR: 1.68, 95% CI: 1.26–2.23, p < 0.0001, I2 = 0%). Besides, while our results supported an age-dependent increase in POD risk, other factors including body-mass index, surgical time, health status, hypertension, diabetes mellitus, and male gender were non-significant predictors of POD.ConclusionOur results demonstrated a negative association between PNI and POD, which warrant further large-scale studies for validation.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD42022323809.

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Section: Discussioncontrasting

confidence: 78%

Association of preoperative prognostic nutritional index with risk of postoperative delirium: A systematic review and meta-analysis

Hung

Chiu²,

Hsu³

et al. 2023

Front. Med.

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“…In contrast, no significant associations were found between POD and other preoperative CSF Alzheimer's disease biomarkers, including preoperative CSF P-tau level ( n = 4, 15.95, 95% CI, −0.48 to 32.381, I 2 : 77%) (Fig. 2, part c), 21,31,32,34 T-tau level ( n = 4, 87.67, 95% CI, −41.23 to 216.57, I 2 : 85%) (Fig. 2, part d), 21,31,32,34 or Aβ42/T-tau level ( n = 2, −0.64, 95% CI, −1.38 to 0.11, I 2 : 86%) (Fig.…”

Section: Resultsmentioning

confidence: 91%

“…Figure 2 presents the associations between Alzheimer's disease biomarkers and POD. The meta-analysis, which included five studies comprising a total of 1139 participants, 21,31–34 revealed a negative correlation between preoperative CSF Aβ42 levels and POD (−86.1, 95% CI, −114.15 to −58.05, I 2 : 47%) (Fig. 2, part a).…”

Section: Resultsmentioning

confidence: 99%

“…43 Our meta-analysis confirmed this negative correlation between preoperative CSF Ab42 levels and POD based on five studies. 21,[31][32][33][34] Despite the TSA not reaching the required sample size, the Z-curve crossed the TSMB, indicating that this correlation has reached statistical significance. A similar negative relationship was observed between preoperative CSF Ab42 levels and DNCR or POCD when pooling data from five studies.…”

Section: Previous Research Has Established An Association Between Pod...mentioning

confidence: 96%

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Associations between Alzheimer's disease biomarkers and postoperative delirium or cognitive dysfunction

Geng,

Zhang,

Chen

et al. 2023

European Journal of Anaesthesiology

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BACKGROUND The relationship between Alzheimer's disease biomarkers and postoperative complications, such as postoperative delirium (POD) and postoperative cognitive dysfunction (POCD), remains a subject of ongoing debate. OBJECTIVE This meta-analysis aimed to determine whether there is an association between perioperative Alzheimer's disease biomarkers and postoperative complications. DESIGN We conducted a meta-analysis of observational clinical studies that explored the correlation between Alzheimer's disease biomarkers and POD or POCD in patients who have undergone surgery, following PRISMA guidelines. The protocol was previously published (INPLASY: INPLASY202350001). DATA SOURCES A comprehensive search was conducted across PubMed, Embase, Web of Science, and Cochrane databases until March 2023. ELIGIBILITY CRITERIA Surgical patients aged at least 18 years, studies focusing on POD or POCD, research involving Alzheimer's disease biomarkers, including Aβ or tau in blood or cerebrospinal fluid (CSF), and availability of the full text. RESULTS Our meta-analysis included 15 studies: six focusing on POD and nine on POCD. The findings revealed a negative correlation between preoperative CSF β-amyloid 42 (Aβ42) levels and the onset of POD [mean difference −86.1, 95% confidence interval (CI), −114.15 to −58.05, I 2: 47%]; this association was strongly supported by trial sequential analysis (TSA). A similar negative correlation was discerned between preoperative CSF Aβ42 levels and the incidence of POCD (−165.01, 95% CI, −261.48 to −68.53, I 2: 95%). The TSA also provided robust evidence for this finding; however, the evidence remains insufficient to confirm a relationship between other Alzheimer's disease biomarkers [β-amyloid 40 (Aβ40), total tau (T-tau), phosphorylated tau (P-tau), and Aβ42/T-tau ratio] and POD or POCD. CONCLUSION The study results indicate a negative correlation between preoperative CSF Aβ42 levels and the occurrence of both POD and POCD. Future investigations are warranted to identify the predictive cutoff value of preoperative CSF Aβ42 for POD and POCD.

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“…Data for this study were obtained from voluntary participants in the Perioperative Neurocognitive Disorder Risk Factor and Prognosis (PNDRFAP) study between January 2020 and May 2021 (Deng et al, 2022 ), and the Perioperative Neurocognitive Disorder and Biomarker Lifestyle (PNDABLE) study between November 2020 and December 2021 (Lin et al, 2021 ; Wang et al, 2021 ).…”

Section: Methodsmentioning

confidence: 99%

Potential Value of Serum Uric Acid in the Identification of Postoperative Delirium in Geriatric Patients Undergoing Knee Replacement

Wang

Tang

Wang

et al. 2022

Front. Aging Neurosci.

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ObjectivesThe relationship between preoperative serum uric acid (SUA) and cerebrospinal fluid (CSF) Alzheimer-related biomarkers were investigated to determine whether high SUA is a potential risk factor for postoperative delirium (POD) and to evaluate its predictive efficacy.MethodsThe participants were selected from the Perioperative Neurocognitive Disorder Risk Factor and Prognosis (PNDRFAP) study and the Perioperative Neurocognitive Disorder and Biomarker Lifestyle (PNDABLE) study. The logistic regression equation was used to analyze the risk factors and protective factors of POD. The interaction term (SUA × Sex) was introduced into the linear model to explore the potential modification effects of sex on the identified correlations. We analyzed the mediating effects of Alzheimer-related biomarkers. Finally, we constructed the receiver operating characteristic (ROC) curve and the nomogram model to evaluate the efficacy of SUA and Alzheimer-related biomarkers in predicting POD.ResultsPatients with POD had elevated SUA level (PNDRFAP: p = 0.002, PNDABLE: p < 0.001). Preoperative SUA level was positively correlated with CSF phosphorylated tau (P-tau) (p = 0.027) and β-amyloid42 (Aβ42)/P-tau (p = 0.023). Interaction analysis did not find any modification effect of sex. The relationship between SUA and POD was partially mediated by CSF P-tau (15.3%). ROC curve showed that the model combining SUA and Alzheimer-related biomarkers had better performance in predicting POD [area under the curve (AUC) = 0.880; p < 0.001], and the predictive model is accurate.ConclusionsHigh SUA may enhance CSF P-tau level, thus increasing the risk of POD, and the model combining SUA and Alzheimer-related biomarkers can accurately predict the occurrence of POD.

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The relationship between body mass index and postoperative delirium

Cited by 21 publications

References 53 publications

Association of preoperative prognostic nutritional index with risk of postoperative delirium: A systematic review and meta-analysis

Association of preoperative prognostic nutritional index with risk of postoperative delirium: A systematic review and meta-analysis

Associations between Alzheimer's disease biomarkers and postoperative delirium or cognitive dysfunction

Potential Value of Serum Uric Acid in the Identification of Postoperative Delirium in Geriatric Patients Undergoing Knee Replacement

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