Systemic Inflammation and Metabolic Changes After Cardiac Surgery and Postoperative Delirium Risk.

Area of Science:

• Geriatric Medicine
• Surgical Complications
• Neuroinflammation

Background:

• Postoperative delirium (POD) is a significant complication in elderly surgical patients.
• Molecular mechanisms underlying POD are not fully understood.
• Cardiac surgery is associated with neurological injury markers, suggesting systemic responses are key.

Purpose of the Study:

• To characterize the systemic inflammatory and metabolic response to cardiac surgery.
• To identify molecular pathways involved in POD pathogenesis.
• To explore the relationship between POD and patient factors like cognition and systemic derangement.

Main Methods:

• Proteomic analysis of serum samples from 78 cardiac surgery patients (pre- and post-op).
• Comparison of proteomic profiles between patients with and without POD.
• Development of a composite metabo-inflammatory score (MIF) to quantify systemic changes.

Main Results:

• Cardiac surgery induced significant inflammatory responses (IL-6, CRP, serum amyloid A) in all patients.
• POD cases exhibited greater metabo-inflammatory shifts compared to controls.
• Lower baseline cognition and higher MIF scores were independent predictors of POD risk.

Conclusions:

• Cardiac surgery with cardiopulmonary bypass triggers a substantial metabo-inflammatory response.
• Patients developing POD show a disproportionately amplified systemic dysregulation.
• Understanding these systemic shifts is crucial for managing POD in geriatric surgical care.