Alterations in the gut microbiome and metabolome in elderly patients with postoperative delirium: A prospective nested case-control study

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia Pub Date : 2025-04-01 DOI:10.1016/j.jclinane.2025.111833

Jiang Huo MD , Shiyi Han MD , Xinyu Hao MD , Zhikang Zhou BD , Jingsheng Lou MD, PhD , Hao Li MD, PhD , Jiangbei Cao MD, PhD , Yingqun Yu MD, PhD , Weidong Mi MD, PhD , Yanhong Liu MD, PhD

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引用次数: 0

Abstract

Objective

To elucidate the role of gut microbiota and their metabolites, including short-chain fatty acids (SCFAs) and targeted metabolomics, in the development of postoperative delirium (POD) in elderly patients.

Design

Prospective nested case-control study.

Setting

A Chinese tertiary hospital.

Participants

Elderly patients underwent elective orthopedic surgery.

Methods

Participants were assessed for POD using the 3-min Diagnostic Confusion Assessment Method (3D-CAM). Biological samples, including feces and plasma, were collected. A 1:1 propensity score matching (PSM) was conducted to match POD cases with non-POD cases. 16S ribosomal RNA (rRNA) sequencing and metabolomics analyses were performed on the matched case series. Predictive models were developed using logistic regression analysis, incorporating bacterial genera and metabolites that exhibited significant differences between the two groups as predictors.

Results

Among 234 patients who were followed up, 41 were diagnosed with POD. A total of 39 cases were matched for both the POD and control groups using PSM. No significant differences were found in the α-diversity and β-diversity of preoperative gut microbiota between the two groups. However, specific bacterial genera, including Romboutsia, Bacteroides faecalis, Blautia mucilaginosa, and Eggerthella lenta, exhibited significant differences. The risk of POD was associated with higher postoperative plasma levels of propionic acid, histidine, aspartate, and ornithine. Logistic regression and receiver operating characteristic curve analyses revealed that indicators derived from the gut microbiota and metabolites could predict POD, with an area under the curve of 0.8413 (95 % confidence interval (CI): 0.7393–0.9434).

Conclusion

This study identified four preoperative bacterial genera and four postoperative plasma metabolites associated with an increased risk of POD in elderly orthopedic patients, suggesting the potential of gut microbiota and metabolite profiles as biomarkers for improving risk prediction and guiding interventions.

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老年术后谵妄患者肠道微生物组和代谢组的改变：一项前瞻性巢式病例对照研究

目的探讨肠道菌群及其代谢产物，包括短链脂肪酸（SCFAs）和靶向代谢组学在老年患者术后谵妄（POD）发生中的作用。前瞻性巢式病例对照研究。中国三级医院。参与者：接受选择性骨科手术的老年患者。方法采用3分钟诊断混淆评估法（3D-CAM）对受试者进行POD评估。收集生物样本，包括粪便和血浆。采用1:1的倾向评分匹配（PSM）将POD病例与非POD病例进行匹配。对匹配病例序列进行16S核糖体RNA （rRNA）测序和代谢组学分析。使用逻辑回归分析建立预测模型，将两组之间表现出显著差异的细菌属和代谢物作为预测因子。结果在随访的234例患者中，41例确诊为POD。使用PSM的POD组和对照组共匹配39例。两组术前肠道菌群α-多样性和β-多样性差异无统计学意义。然而，特定的细菌属，包括Romboutsia， Bacteroides faecalis， Blautia mucilaginosa和Eggerthella lenta，表现出显著差异。POD的风险与术后血浆丙酸、组氨酸、天冬氨酸和鸟氨酸水平升高有关。Logistic回归和受试者工作特征曲线分析表明，肠道微生物群和代谢物指标可以预测POD，曲线下面积为0.8413（95%可信区间（CI）： 0.7393 ~ 0.9434）。结论本研究确定了4种术前细菌属和4种术后血浆代谢物与老年骨科患者POD风险增加相关，提示肠道微生物群和代谢物谱可能作为改善风险预测和指导干预的生物标志物。

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

Journal of Clinical Anesthesia 医学-麻醉学

CiteScore

7.40

自引率

4.50%

发文量

346

审稿时长

23 days

期刊介绍： The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.