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High Preoperative Plasma Neopterin Predicts Delirium After Cardiac Surgery in Older Adults
Author(s) -
Osse Robert J.,
Fekkes Durk,
Tulen Joke H. M.,
Wierdsma André I.,
Bogers Ad J. J. C.,
Mast Rose C.,
Hengeveld Michiel W.
Publication year - 2012
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.2011.03885.x
Subject(s) - medicine , neopterin , delirium , odds ratio , comorbidity , cohort , postoperative cognitive dysfunction , prospective cohort study , cardiac surgery , cardiology , surgery , anesthesia , cognition , intensive care medicine , psychiatry
Objectives To examine the association between plasma levels of pterins and amino acids and postoperative delirium. Design Prospective cohort study. Setting Cardiothoracic service in an university hospital in Rotterdam, the Netherlands. Participants One hundred twenty‐five individuals aged 70 and older undergoing elective cardiac surgery. Measurements Plasma pterins and amino acids were measured pre‐ and postoperatively. Using multiple logistic regression analyses, the associations between pterins and amino acid levels and postoperative delirium were examined in relation to age, sex, comorbidity, cognitive functioning (Mini‐Mental State Examination ( MMSE ) score), and cardiac risk factors. Results Delirium incidence in the main study group was 31.3%. The preoperative measures associated with delirium were neopterin (odds ratio ( OR ) = 1.05, P = .009); MMSE score less than 28 ( OR = 4.39, P = .001); European System for Cardiac Operative Risk Evaluation score greater than 6 ( OR = 2.84, P = .03); and combined coronary artery bypass graft ( CABG ) and aortic, mitral, or tricuspid valve surgery ( OR = 4.32, P = .01). Postoperative measures associated with delirium were neopterin ( OR = 3.84, P = .02), homovanillic acid ( HVA , OR = 1.01, P = .04), and preoperative MMSE score less than 28 ( OR = 3.32, P = .008). Conclusion Preoperatively high neopterin levels predicted delirium after cardiac surgery in older adults, in addition to the well‐known risk factors of poor cognitive function, high cardio‐surgical risk, and combined CABG and valve surgery. Postoperative neopterin and HVA levels were also found to be associated with delirium, together with preoperative cognitive functioning. Plasma neopterin may be a candidate biomarker for delirium after cardiac surgery in these older adults.