title: Postoperative serum thioredoxin concentrations correlate with delirium and cognitive dysfunction after hip fracture surgery in elderly patients.
abstract: BACKGROUND
  Oxidative stress correlates with occurrence and development of postoperative delirium (POD) and cognitive dysfunction (POCD). Thioredoxin (TRX) is a potent anti-oxidant and its circulating concentrations reflect extent of brain injury. We determined the relation of serum TRX concentrations to POD and POCD in elderly patients undergoing hip fracture surgery.
  
  
  METHODS
  In this prospective, observatory study, TRX concentrations in preoperative and postoperative serum from 192 patients and serum from 192 controls were measured using an enzyme-linked immunosorbent assay. The relationship between TRX concentrations and risk of POD and POCD was assessed using a multivariate analysis.
  
  
  RESULTS
  As compared to the controls, postoperative, but not preoperative serum TRX concentrations were significantly increased in the patients. Furthermore, postoperative TRX concentrations and age were identified as the independent predictors for POD and POCD. Also, area under receiver operating characteristic curve (AUC) of postoperative TRX concentrations was obviously higher than that of age in the prediction of POD and POCD. Additionally, in a combined logistic-regression model, TRX concentrations significantly improved the AUCs of age to predict POD and POCD.
  
  
  CONCLUSIONS
  TRX in postoperative serum may be a potential biomarker to predict POD and POCD in elder patients undergoing hip fracture surgery.
authors.affiliation: Department of Anesthesiology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, 158 Shangtang Road, Hangzhou 310014, Zhejiang Province, China.
authors.forename: Xiao-Min
authors.initials: XM
authors.lastname: Wu
authors.affiliation: Department of Anesthesiology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, 158 Shangtang Road, Hangzhou 310014, Zhejiang Province, China.
authors.forename: Wei-Cai
authors.initials: WC
authors.lastname: Xu
authors.affiliation: Department of Anesthesiology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, 158 Shangtang Road, Hangzhou 310014, Zhejiang Province, China.
authors.forename: Yong-Jian
authors.initials: YJ
authors.lastname: Yu
authors.affiliation: Department of Anesthesiology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, 158 Shangtang Road, Hangzhou 310014, Zhejiang Province, China.
authors.forename: Liang
authors.initials: L
authors.lastname: Han
authors.affiliation: Department of Orthopedics, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, 158 Shangtang Road, Hangzhou 310014, Zhejiang Province, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Department of Pharmacy, Hangzhou Third Hospital, 38 West Lake Avenue, Hangzhou 310009, Zhejiang Province, China. Electronic address: hzchenjingsen@163.com.
authors.forename: Li-Jiao
authors.initials: LJ
authors.lastname: Yang
mesh_terms: D000367:Age Factors; D000368:Aged; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D003072:Cognition Disorders / Q000097:blood* / Q000209:etiology; D003693:Delirium / Q000097:blood* / Q000209:etiology; D006620:Hip Fractures / Q000150:complications* / Q000601:surgery; D006801:Humans; D011184:Postoperative Period; D011446:Prospective Studies; D013879:Thioredoxins / Q000097:blood*
chemical_list: D015415:Biomarkers; C491203:TXN protein, human; D013879:Thioredoxins
keywords: Cognitive dysfunction; Delirium; Elderly; Hip fracture; Postoperative; Thioredoxin