Evidence map›Paper›PMID 35144802›Full record

ArticleBritish journal of anaesthesia2022

Postoperative delirium and changes in the blood-brain barrier, neuroinflammation, and cerebrospinal fluid lactate: a prospective cohort study.

Jennifer Taylor, Margaret Parker, Cameron P Casey, Sean Tanabe, David Kunkel, Cameron Rivera, Henrik Zetterberg, Kaj Blennow, Robert A Pearce, Richard C Lennertz and 1 more

3 registry-linked trialsOpen access · greenAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in British journal of anaesthesia, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 3 registered trials, which are not on this map. Cited by 128 papers, 9 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
128citing papers in PubMed, 9 pooled it
25.5field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT01980511 completednot on this map

Detection and Neurological Impact of CerebroVascular Events In Noncardiac Surgery PatIents: A COhort EvaluatioN

TypeobservationalSponsorMcMaster UniversityRan2014 to 2018Enrolled1,116ConditionsCovert Postoperative Stroke
NCT02926417 completednot on this map

Interventions for Postoperative Delirium: Biomarker-2 (IPOD-B2) Pilot Study

TypeobservationalSponsorUniversity of Wisconsin, MadisonRan2016 to 2019Enrolled32ConditionsDeliriumArmsHigh Density-Electroencephalogram
NCT03124303 recruitingnot on this map

Interventions for Postoperative Delirium: Biomarker-3

TypeobservationalSponsorUniversity of Wisconsin, MadisonRan2017 to 2029Enrolled468ConditionsDeliriumArmsHigh Density-Electroencephalogram, Magnetic Resonance Imaging, Blood specimen collection, Pupillometry
3 · Its place in the literature

Who cites it

128 citing papers in PubMed, 9 syntheses or guidelines pooled it, 178 citations in OpenAlex.

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  19. Serum Albumin Level at Intensive Care Unit Admission and Delirium Duration and Severity in Critically Ill Adults.American journal of critical care : an official publication, American Association of Critical-Care Nurses · 2024
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68 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

11 authors at 4 institutions in 4 countries.

Jennifer TaylorCentral Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, NSW, Australia.
Margaret ParkerDepartment of Anesthesiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA.
Cameron P CaseyDepartment of Anesthesiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA.
Sean TanabeDepartment of Anesthesiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA.
David KunkelDepartment of Anesthesiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA.
Cameron RiveraDepartment of Anesthesiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA.
Henrik ZetterbergDepartment of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK; UK Dementia Research Institute at UCL, London, UK; Hong Kong Center for Neurodegenerative Diseases, Hong Kong, China.
Kaj BlennowDepartment of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.
Robert A PearceDepartment of Anesthesiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA.
Richard C LennertzDepartment of Anesthesiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA.
Robert D SandersCentral Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, NSW, Australia. Electronic address: robert.sanders@sydney.edu.au.
University of Wisconsin–Madison · USThe University of Sydney · AUSahlgrenska University Hospital · SEUniversity of Gothenburg · SE

Funding

Clarifying the overlapping pathology of delirium and dementiaR01AG063849 · NIA · UNIVERSITY OF WISCONSIN-MADISON · PI Richard C Lennertz, Robert D Sanders · 2019 to 2026
$5.0M
The Cognitive Disintegration Model of Delirium: A Clinical Cohort Study Investigating Neural Network Connectivity and Local Slow Wave ActivityK23AG055700 · NIA · UNIVERSITY OF WISCONSIN-MADISON · PI SANDERS, ROBERT D · 2018 to 2020
$483k
NIA NIH HHS K23 AG055700NIA NIH HHS R01 AG063849
6 · The paper itself

Abstract

backgroundCase-control studies have associated delirium with blood-brain barrier (BBB) permeability. However, this approach cannot determine whether delirium is attributable to high pre-existing permeability or to perioperative changes. We tested whether perioperative changes in cerebrospinal fluid/plasma albumin ratio (CPAR) and plasma S100B were associated with delirium severity.

methodsParticipants were recruited to two prospective cohort studies of non-intracranial surgery (NCT01980511, NCT03124303, and NCT02926417). Delirium severity was assessed using the Delirium Rating Scale-98. Delirium incidence was diagnosed with the 3D-Confusion Assessment Method (3D-CAM) or CAM-ICU (CAM for the ICU). CSF samples from 25 patients and plasma from 78 patients were analysed for albumin and S100B. We tested associations between change in CPAR (n=11) and S100B (n=61) and delirium, blood loss, CSF interleukin-6 (IL-6), and CSF lactate.

resultsThe perioperative increase in CPAR and S100B correlated with delirium severity (CPAR ρ=0.78, P=0.01; S100B ρ=0.41, P<0.001), delirium incidence (CPAR P=0.012; S100B P<0.001) and CSF IL-6 (CPAR ρ=0.66 P=0.04; S100B ρ=0.75, P=0.025). Linear mixed-effect analysis also showed that decreased levels of S100B predicted recovery from delirium symptoms (P=0.001). Linear regression demonstrated that change in plasma S100B was independently associated with surgical risk, cardiovascular surgery, blood loss, and hypotension. Blood loss also correlated with CPAR (ρ=0.64, P=0.04), S100B (ρ=0.70, P<0.001), CSF lactate (R=0.81, P=0.01), and peak delirium severity (ρ=0.36, P=0.01).

conclusionPostoperative delirium is associated with a breakdown in the BBB. This increased permeability is dynamic and associated with a neuroinflammatory and lactate response. Strategies to mitigate blood loss may protect the BBB.

Indexed as

Blood-Brain BarrierDeliriumBiomarkersHumansInterleukin-6Lactic AcidNeuroinflammatory DiseasesProspective StudiesS100 Calcium Binding Protein beta SubunitBiomarkersInterleukin-6Lactic AcidS100 Calcium Binding Protein beta Subunitdeliriumdementiainflammationneuronal injuryolder adultssurgery

Identifiers

PMID35144802
PMCPMC9465948
OpenAlexW4210922057

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.