The relation between postoperative cognitive disorders and brain damage biomarkers after major urologic surgery: a...

Postoperative neurocognitive disorders (PNDs) are highly prevalent among the elderly population. Identifying an ideal biomarker for postoperative delirium (POD) and postoperative cognitive dysfunction (POCD) remains a significant challenge. This study aimed to investigate the relationship between these syndromes and various biomarkers, including S-100β, neuron-specific enolase (NSE), interleukin-6 (IL-6), and high-mobility group box-1 (HMGB-1).

The study included patients aged 60 years and older who underwent surgery for primary urologic malignancies. POD was evaluated in the recovery room using the Confusion Assessment Method (CAM). POCD was assessed preoperatively and at the first week (POCD1) and third month (POCD3) postoperatively using Addenbrooke's Cognitive Examination-III (ACE-III). Biomarker levels of S-100β, neuron-specific enolase (NSE), interleukin-6 (IL-6), and high-mobility group box-1 (HMGB-1) were measured using enzyme-linked immunosorbent assay (ELISA).

A total of 54 patients completed the study. POD was diagnosed in 12 patients (22.2%), while POCD1 and POCD3 were identified in 17 (31.5%) patients and 12 (22.2%) patients respectively. The mean age of the participants was 73.8 ± 7.1 years. Preoperative levels of NSE were significantly higher in patients with POD compared to those without (p = 0.04). Additionally, preoperative and postoperative IL-6 levels, as well as preoperative and postoperative S-100β levels, were significantly elevated in patients with POCD1 compared to those without (p < 0.01, p = 0.01, p < 0.01, and p = 0.03, respectively). Furthermore, preoperative IL-6 and S-100β levels were higher in patients with POCD3 compared to those without (p = 0.01 and p = 0.03, respectively).

In major urologic oncologic surgeries among geriatric patients, IL-6 and S-100β were found to be associated with both POD and POCD, while NSE was specifically associated with POD.