title: Insulin resistance plays a potential role in postoperative cognitive dysfunction in patients following cardiac valve surgery.
abstract: Severe insulin resistance (IR) promotes the development of Alzheimer disease. IR and postoperative cognitive dysfunction (POCD) are a common complication during the cardiac perioperative period. The authors hypothesized that IR of individuals with cardiac valve surgery would have increased the risk of POCD. The purpose of the study was to analyze the association of IR and POCD after cardiac valve surgery. Total 131 patients who underwent valve replacement via cardiopulmonary bypass (CPB) were included. Cognitive function was assessed by a series of neuropsychological measurements at 1day before and 7days after the surgery. 40 healthy volunteers as the control group also completed the neuropsychological assessment at the same time point. POCD was identified using the "Z score" method. Fasting blood glucose and insulin levels were detected before anesthesia and at 6h and 7days post-operation. Additionally serum levels of interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α) were measured at 6h post-operation. The insulin resistance index was calculated by "homeostasis model assessment 2" (HOMA2) software. The relationship between IR and POCD or TNF-α, IL-6 was then analyzed. At 7days after surgery, the incidence of POCD was 43.8%. The levels of HOMA2-IR in patients with POCD were significantly higher than those of patients without POCD at 6h and 7days after operation (P<0.05).The levels of serum IL-6 and TNF- α were positively correlated with HOMA2-IR value at 6h after operation (RIL-6=0.426, P<0.01; RTNF-a=0.381, P<0.01). POCD was correlated with the patients' education age (OR=1.062), CPB time (OR=1.018), self-rating depression scale (SDS) score after operation (OR=1.082), HOMA2-IR at 6h (OR=1.110) and 7days (OR=13.762) after operation, IL-6 (OR=1.036) and TNF-α (OR=1.039) at 6h after operation. Our study suggests that IR is correlated with the incidence of POCD and the increase of inflammatory factors.
authors.affiliation: Department of Anesthesiology, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province 646000, China.
authors.forename: Ni
authors.initials: N
authors.lastname: Tang
authors.affiliation: Department of Anesthesiology, Pi County People's Hospital, Chengdu, Sichuan Province 646000, China.
authors.forename: Rongrong
authors.initials: R
authors.lastname: Jiang
authors.affiliation: Department of Anesthesiology, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province 646000, China. Electronic address: wangxiaobin67@163.com.
authors.forename: Xiaobin
authors.initials: X
authors.lastname: Wang
authors.affiliation: Department of Anesthesiology, Xuyong County People's Hospital, Luzhou, Sichuan Province 646000, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Wen
authors.affiliation: Department of Anesthesiology, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province 646000, China.
authors.forename: Li
authors.initials: L
authors.lastname: Liu
authors.affiliation: Department of Anesthesiology, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province 646000, China.
authors.forename: Jiali
authors.initials: J
authors.lastname: Wu
authors.affiliation: Department of Pharmacology, Rush Medical College, Rush University, Chicago, IL 60612, USA.
authors.forename: Chunxiang
authors.initials: C
authors.lastname: Zhang
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose; D002315:Cardiopulmonary Bypass; D060825:Cognitive Dysfunction / Q000209:etiology* / Q000378:metabolism*; D005215:Fasting; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006351:Heart Valves / Q000601:surgery*; D006801:Humans; D007328:Insulin / Q000378:metabolism; D007333:Insulin Resistance / Q000502:physiology; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011183:Postoperative Complications / Q000378:metabolism* / Q000523:psychology*; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; C508600:IL6 protein, human; D007328:Insulin; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha
keywords: Cardiac valve surgery; Insulin resistance; POCD