Preoperative Plasma p-tau231, p-tau181, and p-tau217 Are Associated With Postoperative Delirium: A Prospective Study

The pathophysiology of delirium remains incompletely understood. The relationship between preoperative plasma concentrations of p-tau181, p-tau231, p-tau217, and T-tau proteins and postoperative delirium (POD) needs further validation. We aimed to verify whether these markers can identify and predict the occurrence and severity of POD.

172 Older adults undergoing laparoscopic surgery were selected from a tertiary comprehensive hospital. All patients received intravenous anesthesia. Preoperative plasma concentrations of p-tau181, p-tau231, p-tau217, and T-tau proteins were measured using enzyme-linked immunosorbent assay. The occurrence and severity of POD were respectively assessed using the 3D-CAM and DRS-R-98 scales.

Of 172 patients (mean age: 72 ± 6 years, 34.9% female), 20 (12%) experienced POD. Patients who developed POD had higher preoperative plasma concentrations of p-tau181, p-tau231, p-tau217, and T-tau than those without. After adjusting for age, ASA, and education, preoperative concentrations of p-tau181 (OR 1.05, 95% CI: 1.03-1.08), p-tau217 (OR 1.02, 95% CI: 1.01-1.04), p-tau231 (OR 1.09, 95% CI: 1.04-1.14), and T-tau (OR 1.01, 95% CI: 1.00-1.02) were independently associated with POD (p<.001). Preoperative plasma p-tau231 showed the highest diagnostic performance with an area under the curve of 0.966, surpassing p-tau181 (0.869), p-tau217 (0.775), and T-tau (0.750). P-tau231 also demonstrated the highest sensitivity (0.900) and specificity (0.967) for predicting POD, compared to p-tau181, p-tau217, and T-tau.

Preoperative plasma concentrations of p-tau181, p-tau231, and p-tau217 can effectively predict the occurrence and severity of POD in older adult undergoing laparoscopic surgery, with p-tau231 demonstrating higher predictive value.