High preoperative plasma neopterin predicts delirium after cardiac surgery in older adults.
OBJECTIVE
To examine the association between plasma levels of pterins and amino acids and postoperative delirium.


METHODS
Prospective cohort study.


METHODS
Cardiothoracic service in an university hospital in Rotterdam, the Netherlands.


METHODS
One hundred twenty-five individuals aged 70 and older undergoing elective cardiac surgery.


METHODS
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).


CONCLUSIONS
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.
Department of Psychiatry, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands. r.osse@erasmusmc.nl
Robert J
RJ
Osse
Durk
D
Fekkes
Joke H M
JH
Tulen
André I
AI
Wierdsma
Ad J J C
AJ
Bogers
Rose C
RC
van der Mast
Michiel W
MW
Hengeveld
D000368:Aged; D015415:Biomarkers / Q000097:blood; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002851:Chromatography, High Pressure Liquid; D003693:Delirium / Q000097:blood* / Q000453:epidemiology / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D019798:Neopterin / Q000097:blood*; D009426:Netherlands / Q000453:epidemiology; D011183:Postoperative Complications; D057234:Preoperative Period; D011379:Prognosis; D011446:Prospective Studies
D015415:Biomarkers; D019798:Neopterin