Cerebrospinal fluid biomarkers of neuroinflammation and postoperative neurocognitive disorders in patients undergoing orthopedic surgery.

IF 12.5 2区医学 Q1 SURGERY

International journal of surgery Pub Date : 2025-03-18 DOI:10.1097/JS9.0000000000002344

Huiru Feng, Yang Liu, Xue Wang, Chunxiu Wang, Tianlong Wang

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引用次数: 0

Abstract

Introduction: Postoperative neurocognitive disorders (PNDs) are common postoperative complications that can hinder patients' postoperative recovery. Various studies have investigated the correlations between PNDs and cerebrospinal fluid (CSF) neuroinflammatory biomarkers in orthopedic patients. However, combined evidence is required to confirm the homogeneity and robustness of these findings.

Methods: Observational studies were searched to explore the associations between PNDs and these biomarkers in orthopedic patients. A comprehensive study retrieval was performed in MEDLINE (via OVID), EMBASE, and the Cochrane Library without any restrictions on language or date. Subgroup and sensitivity analyses were performed to confirm robustness of the results.

Result: A total of 27 articles were included in this study. Significant concentration differences were found between PNDs and non-PNDs groups in the majority of preoperative CSF neuroinflammatory biomarkers, particularly in patients with postoperative delirium (POD) and delayed neurocognitive recovery (dNCR). Moderate quality evidence identified that increased preoperative CSF levels of t-Tau (OR: 1.008, 95%CI: 1.005-1.010) and p-Tau (OR: 1.077, 95%CI: 1.042-1.078), along with decreased Aβ42 level (OR: 0.998, 95% CI: 0.997-0.999), were risk factors for POD in orthopedic patients. Low quality evidence suggested that preoperative CSF level of Aβ42/t-Tau was a valuable predictive biomarker for dNCR.

Conclusion: Different subtypes of PNDs after orthopedic surgery have different CSF biomarkers, with POD having the most and postoperative neurocognitive disorder (POCD) having the fewest. Studies concerning dNCR and POCD are needed to investigate their correlations with these biomarkers. Meanwhile, studies concerning diagnostic tests are also highly needed to help screen for practical biomarkers and analyze these biomarkers from a more comprehensive perspective.

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骨科手术患者神经炎症和术后神经认知障碍的脑脊液生物标志物

术后神经认知障碍（pnd）是常见的术后并发症，可阻碍患者术后恢复。各种研究调查了骨科患者pnd与脑脊液（CSF）神经炎症生物标志物之间的相关性。然而，需要综合证据来证实这些发现的同质性和稳健性。方法：通过观察性研究来探讨骨科患者pnd与这些生物标志物之间的关系。在MEDLINE（通过OVID）、EMBASE和Cochrane图书馆中进行全面的研究检索，没有任何语言或日期限制。进行亚组分析和敏感性分析以证实结果的稳健性。结果：本研究共纳入27篇文献。pnd组和非pnd组在大多数术前脑脊液神经炎症生物标志物的浓度存在显著差异，特别是在术后谵妄（POD）和延迟神经认知恢复（dNCR）患者中。中等质量的证据表明，术前脑脊液t-Tau水平升高（OR: 1.008, 95%CI: 1.005-1.010）和p-Tau水平升高（OR: 1.077, 95%CI: 1.042-1.078）以及a - β42水平降低（OR: 0.998, 95%CI: 0.997-0.999）是骨科患者发生POD的危险因素。低质量证据提示术前脑脊液a β42/t-Tau水平是dNCR的有价值的预测生物标志物。结论：骨科术后不同亚型pnd的脑脊液生物标志物不同，以POD最多，术后神经认知障碍（POCD）最少。需要进一步研究dNCR和POCD与这些生物标志物的相关性。同时，也非常需要诊断测试方面的研究，以帮助筛选实用的生物标志物，并从更全面的角度分析这些生物标志物。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International journal of surgery SURGERY-

CiteScore

17.70

自引率

3.30%

发文量

审稿时长

6-12 weeks

期刊介绍： The International Journal of Surgery (IJS) has a broad scope, encompassing all surgical specialties. Its primary objective is to facilitate the exchange of crucial ideas and lines of thought between and across these specialties.By doing so, the journal aims to counter the growing trend of increasing sub-specialization, which can result in "tunnel-vision" and the isolation of significant surgical advancements within specific specialties.