Elevation of monocyte chemoattractant protein-1 in patients experiencing neurocognitive decline following carotid endarterectomy.
BACKGROUND
Previous studies have demonstrated that elevated pre-operative monocyte count is an independent predictor of acute neurocognitive decline following carotid endarterectomy (CEA). Monocyte chemoattractant protein-1 (MCP-1), secreted by human endothelial and monocyte-like cells, is a potent mediator of inflammation and mononuclear cell trafficking. This study examines the relationship between peri-operative serum MCP-1 elevation and post-operative neurocognitive injury following CEA.


METHODS
Fifty-two patients undergoing CEA and 67 lumbar laminectomy (LL) controls were administered a battery of five neuropsychological tests pre-operatively and on post-operative day 1 (POD 1). Change in individual test scores from baseline to POD 1 were converted into Z-score and used to develop a point system quantifying the degree of neurocognitive dysfunction relative to change within the LL group. Neurocognitive injury following CEA was defined as a score greater than 2 standard deviations above mean total deficit scores of LL controls. Serum MCP-1 levels were measured pre-operatively and on POD 1 by enzyme-linked immunosorbent assay.


RESULTS
Mean percent MCP-1 elevation was higher for the 13 injured CEA patients (147.7 +/- 32.4%) in our cohort compared to 39 age- and sex-matched uninjured CEA patients (76.0 +/- 16.5%). In unconditional multivariate logistic regression analysis, percent elevation in serum MCP-1 level was associated with neurocognitive injury one day after CEA (OR = 2.19, 95% CI = 1.13-4.26, P = 0.021, for a 100% elevation from pre-operative levels).


CONCLUSIONS
Peri-operative elevations in serum MCP-1 levels correlate with acute neurocognitive dysfunction following CEA. These data implicate an inflammatory mechanism in the pathogenesis of Ischaemic neurocognitive decline.
Mack
W J
WJ
Department of Neurological Surgery, Columbia University Medical Center, New York, NY 10032, USA.
Ducruet
A F
AF
Hickman
Z L
ZL
Zurica
J
J
Starke
R M
RM
Garrett
M C
MC
Komotar
R J
RJ
Quest
D O
DO
Solomon
R A
RA
Heyer
E J
EJ
Sander Connolly
E
E
D000368:Aged; D018932:Chemokine CCL2 / Q000097:blood*; D003072:Cognition Disorders / Q000175:diagnosis / Q000276:immunology*; D016894:Endarterectomy, Carotid; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007796:Laminectomy; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D009483:Neuropsychological Tests; D011183:Postoperative Complications / Q000175:diagnosis / Q000276:immunology*; D011446:Prospective Studies; D012016:Reference Values
D018932:Chemokine CCL2