Preoperative Serum Metabolites Are Associated With Postoperative Delirium in Elderly Hip-Fracture Patients.
BACKGROUND
Hypotheses on the development of postoperative delirium (PD) include "neuroinflammatory," "neuronal aging," "oxidative stress," "neurotransmitter deficiency," and "neuroendocrine." Here, we employed metabolomics to determine the serum metabolites in the baseline associated with an increased risk of PD.


METHODS
Two hundred and nine elderly hip-fracture patients who had undergone hemiarthroplasty and had completed our assessments were selected. Fasting venous blood was collected at 7:00 on the morning of surgery and a serum sample bank was created for analysis. On the first 3 postoperative days, the patients were assessed twice daily using the Confusion Assessment Method - Chinese Revision. Ultimately, 43 patients were diagnosed with PD, who comprised the PD group. Meanwhile, 43 matched non-PD patients were selected based on age, sex, and body mass index. Serum samples from the two groups were analyzed by gas chromatography-time-of-flight mass spectrometry and Acquity ultra-performance liquid chromatography-quadrupole time-of-flight mass spectrometry.


RESULTS
The demographic characteristics of the groups were matched. Four metabolites associated with an increased risk of PD were identified, including S-methylcysteine, linolenic acid, eicosapentaenoic acid, and linoleic acid.


CONCLUSIONS
Multiple metabolic pathways in the PD group altered before surgery, including deficiency of ω3 and ω6 fatty acids, energy metabolism and oxidative stress with interactions between hypoxia and mitochondrial dysfunction, in addition to glutamate-glutamine cycle dysfunction. These metabolic abnormalities could possibly increase the fragility of the brain and then contribute to PD.
Department of Anesthesiology and Critical Care Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, China.|Department of Anesthesiology and Critical Care Medicine, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, China.
Yong
Y
Guo
Center for Translational Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, China.
Yinan
Y
Zhang
Department of Anesthesiology and Critical Care Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, China.
Peiyu
P
Jia
Department of Anesthesiology and Critical Care Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, China.
Wenying
W
Wang
Department of Anesthesiology and Critical Care Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, China.
Quanhong
Q
Zhou
Department of Anesthesiology and Critical Care Medicine, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, China.
Lulu
L
Sun
Center for Translational Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, China.
Aihua
A
Zhao
Department of Anesthesiology and Critical Care Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, China.
Xin
X
Zhang
Department of Anesthesiology and Critical Care Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, China.
Xuemin
X
Wang
Department of Anesthesiology and Critical Care Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, China.
Yingchuan
Y
Li
Department of Anesthesiology and Critical Care Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, China.
Junfeng
J
Zhang
Department of Anesthesiology and Critical Care Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, China.
Wei
W
Jiang
D000368:Aged; D003693:Delirium / Q000453:epidemiology*; D005260:Female; D006620:Hip Fractures / Q000097:blood* / Q000601:surgery*; D006801:Humans; D008297:Male; D055432:Metabolomics; D011183:Postoperative Complications / Q000453:epidemiology*; D057234:Preoperative Period
Elderly patients; Hip fracture; Metabolomics; Postoperative delirium; Risk metabolites