title: Serum high-mobility group box 1 protein correlates with cognitive decline after gastrointestinal surgery.
abstract: BACKGROUND
  Accumulating evidence has indicated that inflammation may act as a potential mechanism underlying post-operative cognitive dysfunction (POCD). High-mobility group box 1 (HMGB1), as a known late mediator of inflammation, is involved in the development of post-operative complications. Thus, we sought to determine the role of HMGB1 in reflecting POCD following major gastrointestinal surgery.
  
  
  METHODS
  Fifty-three elderly patients undergoing gastrointestinal surgery were recruited, and 50 patients completed the study. Serum HMGB1 and interleukin (IL)-6 levels were measured pre-operatively and at 6 h, day 1 and day 3 post-operatively. Neuropsychological tests were administered before and 1 week after surgery. POCD was determined using a Z score ≥ 1.96.
  
  
  RESULTS
  Seventeen (34%, 17/50) patients developed POCD at 1 week. The POCD group had higher serum HMGB1 levels at day 1 (12.15 ± 3.12 vs. 9.91 ± 3.15 ng/ml, P = 0.021) and day 3 (11.04 ± 2.88 vs. 8.52 ± 3.31 ng/ml, P = 0.011). IL-6 levels at 6 h (51.18 ± 15.22 vs. 39.20 ± 14.32 pg/ml, P = 0.009) and day 1 (41.59 ± 11.08 vs. 33.81 ± 11.42 pg/ml, P = 0.026) were significantly higher in POCD patients. Serum values of IL-6 at 6 h, HMGB1 at day 1 and levels of education showed positive correlations with Z scores. HMGB1 at day 3 and IL-6 at 6 h were independent risk factors.
  
  
  CONCLUSIONS
  Serum HMGB1 and IL-6 levels increase significantly after major gastrointestinal surgery in elderly patients and such elevations are associated with the occurrence of cognitive decline after surgery.
authors.affiliation: Department of Anesthesiology, The Third Xiangya Hospital of Central South University, Changsha, China.
authors.forename: G-X
authors.initials: GX
authors.lastname: Lin
authors.forename: T
authors.initials: T
authors.lastname: Wang
authors.forename: M-H
authors.initials: MH
authors.lastname: Chen
authors.forename: Z-H
authors.initials: ZH
authors.lastname: Hu
authors.forename: W
authors.initials: W
authors.lastname: Ouyang
mesh_terms: D000368:Aged; D000768:Anesthesia, General; D015415:Biomarkers; D003072:Cognition Disorders / Q000097:blood* / Q000175:diagnosis / Q000209:etiology; D058245:Cognitive Reserve; D013505:Digestive System Surgical Procedures; D004522:Educational Status; D017558:Elective Surgical Procedures; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000601:surgery; D024243:HMGB1 Protein / Q000097:blood*; D006801:Humans; D007249:Inflammation / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D008113:Liver Neoplasms / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011183:Postoperative Complications / Q000097:blood* / Q000175:diagnosis / Q000209:etiology / Q000523:psychology; D011446:Prospective Studies
chemical_list: D015415:Biomarkers; D024243:HMGB1 Protein; C585491:HMGB1 protein, human; C508600:IL6 protein, human; D015850:Interleukin-6