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Systemic and Central Nervous System Levels of Neutrophil Gelatinase‐Associated Lipocalin after Cardiac Surgery Are Associated with Postoperative Cognitive Impairment
Author(s) -
Schoemaker Regien G,
Hovens Iris B
Publication year - 2016
Publication title -
the faseb journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.709
H-Index - 277
eISSN - 1530-6860
pISSN - 0892-6638
DOI - 10.1096/fasebj.30.1_supplement.1284.8
Subject(s) - medicine , postoperative cognitive dysfunction , cardiac surgery , lipocalin , anesthesia , systemic inflammation , surgery , inflammation , cognition , psychiatry
Postoperative cognitive dysfunction (POCD) is a debilitating surgical complication, with cardiac surgery patients at particular risk. The systemic and central inflammatory response to surgery is considered to be a key factor in POCD development. Neutrophil gelatinase‐associated lipocalin (NGAL), a sensitive marker for inflammatory damage, has previously been associated with development of depressive symptoms in patients with cardiac disease. The current study aimed to investigate the association of systemic and central NGAL concentrations with postoperative cognitive performance in a rat‐model for POCD. Methods Male Wistar rats were subjected to ischemia reperfusion of the left coronary artery (cardiac surgery), received thoracic sham surgery or remained naïve. Cognitive performance was assessed in the second postoperative week. Two weeks following surgery plasma (ELISA) and brain (immunohistochemistry) NGAL levels were determined. Results NGAL was increased from 80±7 ng/ml in control rats to 321±48 ng/ml (p<0.01) and 278±53 ng/ml (p<0.01) in rats that had undergone thoracic sham surgery or cardiac surgery respectively (F 2,33 =9.4, p<0.01). NGAL in the paraventricular nucleus of the hypothalamus (PVN) was increased significantly after cardiac surgery only (F 2,29 =9.2, p<0.01; control: 13±1%; sham: 15±1%; cardiac: 18±1%, p<0.01). The route of anesthesia did not affect NGAL levels. Plasma NGAL concentrations in cardiac surgery and control rats were significantly correlated with performance in the novel location test (r=−0.46, p=0.04), and learning (r=0.50, p=0.30) and reversal learning (r=0.66, p=<0.01) in the Morris water maze, while PVN NGAL was correlated with novel location recognition only (r=−0.53, p<0.01). Conclusions Opening of the thorax appears to be associated with a marked long‐lasting rise in systemic NGAL concentrations, but only in cardiac surgery this is associated in increased NGAL in the brain, specifically in the PVN. These surgery‐specific alterations in NGAL may provide a lead towards understanding the cognitive sequelae of cardiac surgery