Association of intraoperative changes in brain-derived neurotrophic factor and postoperative delirium in older adults

J. Wyrobek, A. Laflam, L. Max, J. Tian, Karin Jane Neufeld, Khaled M Kebaish, Jeremy D Walston, C. W. Hogue, Lee H Riley, Allen D Everett, Charles Brown

Research output: Contribution to journalArticle

Abstract

Delirium is common after surgery, although the aetiology is poorly defined. Brain-derived neurotrophic factor (BDNF) is a neurotrophin important in neurotransmission and neuroplasticity. Decreased levels of BDNF have been associated with poor cognitive outcomes, but few studies have characterized the role of BDNF perioperatively. We hypothesized that intr aoperative decreases in BDNF levels are associated with postoperative delirium.Methods. Patients undergoing spine surgery were enrolled in a prospective cohort study. Plasma BDNF was collected at baseline and at least hourly intraoperatively. Delirium was assessed using rigorous methods, including the Confusion AssessmentMethod (CAM) and CAMfor the intensive care unit. Associations of changes in BDNF and deliriumwere examined using regressionmodels. Results. Postoperative deliriumdeveloped in 32 of 77 (42%) patients. The median baseline BDNF level was 7.6ngml1 [interquartile range (IQR) 3.0-11.2] and generally declined intraoperatively [median decline 61% (IQR 31-80)]. There was no difference in baseline BDNF levels by deliriumstatus. However, the percent decline in BDNF was greater in patients who developed delirium [median 74% (IQR 51-82)] vs in those who did not develop delirium[median 50% (IQR 14-79); P0.03]. Each 1% decline in BDNF was associated with increased odds of deliriumin unadjusted {odds ratio [OR] 1.02 [95% confidence interval (CI) 1.00-1.04]; P0.01},multivariableadjusted [OR 1.02 (95% CI 1.00-1.03); P0.03], and propensity score-adjusted models [OR 1.02 (95% CI 1.00-1.04); P0.03]. Conclusions. We observed an association between intraoperative decline in plasma BDNF and delirium. These preliminary results need to be confirmed but suggest that plasma BDNF levels may be a biomarker for postoperative delirium.

LanguageEnglish (US)
Pages324-332
Number of pages9
JournalBritish Journal of Anaesthesia
Volume119
Issue number2
DOIs
StatePublished - Aug 1 2017

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Delirium
Brain-Derived Neurotrophic Factor
Odds Ratio
Confidence Intervals
Confusion
Propensity Score
Neuronal Plasticity
Nerve Growth Factors
Synaptic Transmission
Intensive Care Units
Spine
Cohort Studies
Biomarkers
Outcome Assessment (Health Care)
Prospective Studies

Keywords

  • BDNF
  • biological
  • delirium of mixed origin
  • marker

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

@article{8c3f1abf4363436ab0d290e4c867f5bc,
title = "Association of intraoperative changes in brain-derived neurotrophic factor and postoperative delirium in older adults",
abstract = "Delirium is common after surgery, although the aetiology is poorly defined. Brain-derived neurotrophic factor (BDNF) is a neurotrophin important in neurotransmission and neuroplasticity. Decreased levels of BDNF have been associated with poor cognitive outcomes, but few studies have characterized the role of BDNF perioperatively. We hypothesized that intr aoperative decreases in BDNF levels are associated with postoperative delirium.Methods. Patients undergoing spine surgery were enrolled in a prospective cohort study. Plasma BDNF was collected at baseline and at least hourly intraoperatively. Delirium was assessed using rigorous methods, including the Confusion AssessmentMethod (CAM) and CAMfor the intensive care unit. Associations of changes in BDNF and deliriumwere examined using regressionmodels. Results. Postoperative deliriumdeveloped in 32 of 77 (42{\%}) patients. The median baseline BDNF level was 7.6ngml1 [interquartile range (IQR) 3.0-11.2] and generally declined intraoperatively [median decline 61{\%} (IQR 31-80)]. There was no difference in baseline BDNF levels by deliriumstatus. However, the percent decline in BDNF was greater in patients who developed delirium [median 74{\%} (IQR 51-82)] vs in those who did not develop delirium[median 50{\%} (IQR 14-79); P0.03]. Each 1{\%} decline in BDNF was associated with increased odds of deliriumin unadjusted {odds ratio [OR] 1.02 [95{\%} confidence interval (CI) 1.00-1.04]; P0.01},multivariableadjusted [OR 1.02 (95{\%} CI 1.00-1.03); P0.03], and propensity score-adjusted models [OR 1.02 (95{\%} CI 1.00-1.04); P0.03]. Conclusions. We observed an association between intraoperative decline in plasma BDNF and delirium. These preliminary results need to be confirmed but suggest that plasma BDNF levels may be a biomarker for postoperative delirium.",
keywords = "BDNF, biological, delirium of mixed origin, marker",
author = "J. Wyrobek and A. Laflam and L. Max and J. Tian and Neufeld, {Karin Jane} and Kebaish, {Khaled M} and Walston, {Jeremy D} and Hogue, {C. W.} and Riley, {Lee H} and Everett, {Allen D} and Charles Brown",
year = "2017",
month = "8",
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doi = "10.1093/bja/aex103",
language = "English (US)",
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pages = "324--332",
journal = "British Journal of Anaesthesia",
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T1 - Association of intraoperative changes in brain-derived neurotrophic factor and postoperative delirium in older adults

AU - Wyrobek, J.

AU - Laflam, A.

AU - Max, L.

AU - Tian, J.

AU - Neufeld, Karin Jane

AU - Kebaish, Khaled M

AU - Walston, Jeremy D

AU - Hogue, C. W.

AU - Riley, Lee H

AU - Everett, Allen D

AU - Brown, Charles

PY - 2017/8/1

Y1 - 2017/8/1

N2 - Delirium is common after surgery, although the aetiology is poorly defined. Brain-derived neurotrophic factor (BDNF) is a neurotrophin important in neurotransmission and neuroplasticity. Decreased levels of BDNF have been associated with poor cognitive outcomes, but few studies have characterized the role of BDNF perioperatively. We hypothesized that intr aoperative decreases in BDNF levels are associated with postoperative delirium.Methods. Patients undergoing spine surgery were enrolled in a prospective cohort study. Plasma BDNF was collected at baseline and at least hourly intraoperatively. Delirium was assessed using rigorous methods, including the Confusion AssessmentMethod (CAM) and CAMfor the intensive care unit. Associations of changes in BDNF and deliriumwere examined using regressionmodels. Results. Postoperative deliriumdeveloped in 32 of 77 (42%) patients. The median baseline BDNF level was 7.6ngml1 [interquartile range (IQR) 3.0-11.2] and generally declined intraoperatively [median decline 61% (IQR 31-80)]. There was no difference in baseline BDNF levels by deliriumstatus. However, the percent decline in BDNF was greater in patients who developed delirium [median 74% (IQR 51-82)] vs in those who did not develop delirium[median 50% (IQR 14-79); P0.03]. Each 1% decline in BDNF was associated with increased odds of deliriumin unadjusted {odds ratio [OR] 1.02 [95% confidence interval (CI) 1.00-1.04]; P0.01},multivariableadjusted [OR 1.02 (95% CI 1.00-1.03); P0.03], and propensity score-adjusted models [OR 1.02 (95% CI 1.00-1.04); P0.03]. Conclusions. We observed an association between intraoperative decline in plasma BDNF and delirium. These preliminary results need to be confirmed but suggest that plasma BDNF levels may be a biomarker for postoperative delirium.

AB - Delirium is common after surgery, although the aetiology is poorly defined. Brain-derived neurotrophic factor (BDNF) is a neurotrophin important in neurotransmission and neuroplasticity. Decreased levels of BDNF have been associated with poor cognitive outcomes, but few studies have characterized the role of BDNF perioperatively. We hypothesized that intr aoperative decreases in BDNF levels are associated with postoperative delirium.Methods. Patients undergoing spine surgery were enrolled in a prospective cohort study. Plasma BDNF was collected at baseline and at least hourly intraoperatively. Delirium was assessed using rigorous methods, including the Confusion AssessmentMethod (CAM) and CAMfor the intensive care unit. Associations of changes in BDNF and deliriumwere examined using regressionmodels. Results. Postoperative deliriumdeveloped in 32 of 77 (42%) patients. The median baseline BDNF level was 7.6ngml1 [interquartile range (IQR) 3.0-11.2] and generally declined intraoperatively [median decline 61% (IQR 31-80)]. There was no difference in baseline BDNF levels by deliriumstatus. However, the percent decline in BDNF was greater in patients who developed delirium [median 74% (IQR 51-82)] vs in those who did not develop delirium[median 50% (IQR 14-79); P0.03]. Each 1% decline in BDNF was associated with increased odds of deliriumin unadjusted {odds ratio [OR] 1.02 [95% confidence interval (CI) 1.00-1.04]; P0.01},multivariableadjusted [OR 1.02 (95% CI 1.00-1.03); P0.03], and propensity score-adjusted models [OR 1.02 (95% CI 1.00-1.04); P0.03]. Conclusions. We observed an association between intraoperative decline in plasma BDNF and delirium. These preliminary results need to be confirmed but suggest that plasma BDNF levels may be a biomarker for postoperative delirium.

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