Annals of Neurology: Patients with high levels of NfL after surgery are more likely to develop delirium

Delirium is an acute decline in cognition and attention, a common complication of diseases, acute trauma and surgery in the elderly, associated with increased morbidity and mortality.
currently, there is limited understanding of delirium pathophysiology, but new evidence suggests that neuron damage may play a role.
of liquid biomarkers for neuron damage have been studied under a range of conditions, including traumatic brain injury (TBI), multiple sclerosis, stroke and neurodegenerative diseases.
in delirium, previous studies of plasma markers for neuron damage have been mixed.
, for example, S100B, an indicator of glial activation or death, has been found to have elevated or unchanged S100B in patients with persistent delirium compared to possible Alzheimer's disease (AD) patients.
Neuron-specific oleolase (NSE) is a highly specific marker of neurons and exocyte endocrine cells with different results, with one study showing lower NSE levels in cerebrospinal fluid (CSF) in patients with delirium, others reporting higher plasma NSE concentrations, and some studies have found no significant differences between delirium and control groups.
with the development of hypersensitive immunometrics, other neuron damage markers can be detected from the blood and need to be studied.
e.g., neuroseed light chain protein (NfL), a highly expressive cylindrical intermediate silk protein that provides structural myelin axon support, increases blood levels in stroke, traumatic shock, multiple diseases, and more.
sclerosis, AD, aggressive nuclear paralysis, and frontal dementia, and increases in CSF are directly related to the extent of axon damage in the blood.
, what is the specific relationship between NfL and postoperative delirium? Tamara G. Fong of Harvard University and others systematically explored the relationship between NfL and delirium severity and cognitive performance.
they were included in the delirium-no delirium combination, which was 108 pairs and matched by age, sex, type of surgery, cognition, and vascular comedies.
use Simera technology (Quanterix, Lexington, MA) to measure biomarkers in plasma collected before surgery (PREOP), 2 days after surgery (POD2) and 30 days (PO1MO).
and use confusion assessment methods (Confusion Assessment Method, CAM,) and CAM-S (Severity) to measure the severity of delirium and delirium.
cognitive function is measured using a General Cognitive Competence (GCP) score.
showed that there was a higher NfL in POD2 and PO1MO in delirium cases.
of delirium increased in patients with PREOP and POD2 NfL with a maximum quarterback (Q4) (adjusted odds were 3.7 and 4.6, respectively) and experienced more severe delirium.
at PO1MO, the NfL of delirium cases continued to be high (adjusted OR=9.7), and the GCP score of cases with Q4 NfL value decreased by -2.3 points (-2.3 points).
significance of this study is that patients with the highest levels of PREOP or POD2 NfL were found to be more prone to delirium.
NfL increase in PO1MO is associated with delirium and greater cognitive decline.
results suggest that NfL may be a useful biomarker for predicting delirium risk and long-term cognitive decline, providing pathophysiological evidence for neural axon injury after delirium.
origin: Fong, T. G., Vasunilashorn, S.M., Ngo, L., Libermann, T. A., Dillon, S.T., Schmitt, E.M., ... & SAGES Study Group. (2020). Association of Plasma Neurofilament Light with Postoperative Delirium. Annals of Neurology, 88(5), 984-994.<!--5f39ae17-8c62-4a45-bc43-b32064c9388a: W3siYmxvY2tJZCI6Ijc0NTQtMTYxMDQ4NzY4NDUwNSIsImJsb2NrVHlwZSI6InBhcmFncmFwaCIsInN0eWxlcyI6eyJhbGlnbiI6ImxlZnQiLCJpbmRlbnQiOjAsInRleHQtaW5kZW50IjowLCJsaW5lLWhlaWdodCI6MS43NSwiYmFjay1jb2xvciI6IiIsInBhZGRpbmciOiIifSwidHlwZSI6InBhcmFncmFwaCIsInJpY2hUZXh0Ijp7ImRhdGEiOlt7ImNoYXIiOiJBIiwic3R5bGVzIjp7ImJhY2stY29sb3IiOiIjZmZmZmZmIn19LHsiY2hhciI6Im4iLCJzdHlsZXMiOnsiYmFjay1jb2xvciI6IiNmZmZmZmYifX0seyJjaGFyIjoibiIsInN0eWxlcyI6e yJiYWNrLWNvbG9yIjoiI2ZmZmZmZiJ9fSx7ImNoYXIiOiJhIiwic3R5bGVzIjp7ImJhY2stY29sb3IiOiIjZmZmZmZmIn19LHsiY2hhciI6ImwiLCJzdHlsZXMiOnsiYmFjay1jb2xvciI6IiNmZmZmZmYifX0seyJjaGFyIjoicyIsInN0eWxlcyI6eyJiYWNrLWNvbG9yIjoiI2ZmZmZmZiJ9fSx7ImNoYXIiOiIgIiwic3R5bGVzIjp7ImJhY2stY29sb3IiOiIjZmZmZmZmIn19LHsiY2hhciI6Im8iLCJzdHlsZXMiOnsiYmFjay1jb2xvciI6IiNmZmZmZmYifX0seyJjaGFyIjoiZiIsInN0eWxlcyI6eyJiYWNrLWNvbG9yIjoiI2ZmZmZmZiJ9fSx7ImNoYX IiOiIgIiwic3R5bGVzIjp7ImJhY2stY29sb3IiOiIjZmZmZmZmIn19LHsiY2hhciI6Ik4iLCJzdHlsZXMiOnsiYmFjay1jb2xvciI6IiNmZmZmZmYifX0seyJjaGFyIjoiZSIsInN0eWxlcyI6eyJiYWNrLWNvbG9yIjoiI2ZmZmZmZiJ9fSx7ImNoYXIiOiJ1Iiwic3R5bGVzIjp7ImJhY2stY29sb3IiOiIjZmZmZmZmIn19LHsiY2hhciI6InIiLCJzdHlsZXMiOnsiYmFjay1jb2xvciI6IiNmZmZmZmYifX0seyJjaGFyIjoibyIsInN0eWxlcyI6eyJiYWNrLWNvbG9yIjoiI2ZmZmZmZiJ9fSx7ImNoYXIiOiJsIiwic3R5bGVzIjp7ImJhY2stY29sb3IiOiI jZmZmZmZmIn19LHsiY2hhciI6Im8iLCJzdHlsZXMiOnsiYmFjay1jb2xvciI6IiNmZmZmZmYifX0seyJjaGFyIjoiZyIsInN0eWxlcyI6eyJiYWNrLWNvbG9yIjoiI2ZmZmZmZiJ9fSx7ImNoYXIiOiJ5Iiwic3R5bGVzIjp7ImJhY2stY29sb3IiOiIjZmZmZmZmIn19LHsiY2hhciI6Iu+ 8miIsInN0eWxlcyI6eyJiYWNrLWNvbG9yIjoiI2ZmZmZmZiJ9fSx7ImNoYXIiOiLmnK8iLCJzdHlsZXMiOnsiYmFjay1jb2xvciI6IiNmZmZmZmYifX0seyJjaGFyIjoi5ZCOIiwic3R5bGVzIjp7ImJhY2stY29sb3IiOiIjZmZmZmZmIn19LHsiY2hhciI6Ik4iLCJzdHlsZXMiOnsiYmFjay1jb2xvciI6IiNmZmZmZmYifX0seyJjaGFyIjoiZiIsInN0eWxlcyI6eyJiYWNrLWNvbG9yIjoiI2ZmZmZmZiJ9fSx7ImNoYXIiOiJMIiwic3R5bGVzIjp7ImJhY2stY29sb3IiOiIjZmZmZmZmIn19LHsiY2hhciI6IuawtCIsInN0eWxlcyI6eyJiYWNrLWNvbG9y IjoiI2ZmZmZmZiJ9fSx7ImNoYXIiOiLlubMiLCJzdHlsZXMiOnsiYmFjay1jb2xvciI6IiNmZmZmZmYifX0seyJjaGFyIjoi6auYIiwic3R5bGVzIjp7ImJhY2stY29sb3IiOiIjZmZmZmZmIn19LHsiY2hhciI6IueahCIsInN0eWxlcyI6eyJiYWNrLWNvbG9yIjoiI2ZmZmZmZiJ9fSx7ImNoYXIiOiLmgqMiLCJzdHlsZXMiOnsiYmFjay1jb2xvciI6IiNmZmZmZmYifX0seyJjaGFyIjoi6ICFIiwic3R5bGVzIjp7ImJhY2stY29sb3IiOiIjZmZmZmZmIn19LHsiY2hhciI6IuabtCIsInN0eWxlcyI6eyJiYWNrLWNvbG9yIjoiI2ZmZmZmZiJ9fSx7ImNoY XIiOiLlrrkiLCJzdHlsZXMiOnsiYmFjay1jb2xvciI6IiNmZmZmZmYifX0seyJjaGFyIjoi5piTIiwic3R5bGVzIjp7ImJhY2stY29sb3IiOiIjZmZmZmZmIn19LHsiY2hhciI6IuWHuiIsInN0eWxlcyI6eyJiYWNrLWNvbG9yIjoiI2ZmZmZmZiJ9fSx7ImNoYXIiOiLnjrAiLCJzdHlsZXMiOnsiYmFjay1jb2xvciI6IiNmZmZmZmYifX0seyJjaGFyIjoi6LC1Iiwic3R5bGVzIjp7ImJhY2stY29sb3IiOiIjZmZmZmZmIn19LHsiY2hhciI6IuWmhCIsInN0eWxlcyI6eyJiYWNrLWNvbG9yIjoiI2ZmZmZmZiJ9fV0sImlzUmljaFRleHQiOnRydWUsImtlZX BMaW5lQnJlYWsiOnRydWV9fSx7ImJsb2NrSWQiOiIzNzMwLTE2MTA0ODg4NjEyMDciLCJibG9ja1R5cGUiOiJwYXJhZ3JhcGgiLCJzdHlsZXMiOnsiYWxpZ24iOiJsZWZ0IiwiaW5kZW50IjowLCJ0ZXh0LWluZGVudCI6MCwibGluZS1oZWlnaHQiOjEuNzUsImJhY2stY29sb3IiOiIiLCJwYWRkaW5nIjoiIn0sInR5cGUiOiJwYXJhZ3JhcGgiLCJyaWNoVGV4dCI6eyJkYXRhIjpbeyJjaGFyIjoiwqAiLCJzdHlsZXMiOnsiYmFjay1jb2xvciI6IiNmZmZmZmYifX1dLCJpc1JpY2hUZXh0Ijp0cnVlLCJrZWVwTGluZUJyZWFrIjp0cnVlfX0seyJibG9ja0l kIjoiNjg0NS0xNjEwNDg4ODEyMDkzIiwiYmxvY2tUeXBlIjoicGFyYWdyYXBoIiwic3R5bGVzIjp7ImFsaWduIjoibGVmdCIsImluZGVudCI6MCwidGV4dC1pbmRlbnQiOjAsImxpbmUtaGVpZ2h0IjoxLjc1LCJiYWNrLWNvbG9yIjoiIiwicGFkZGluZyI6IiJ9LCJ0eXBlIjoicGFyYWdyYXBoIiwicmlja