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Association Between Plasma Neurofilament Light Concentration and Postoperative Delirium After Cardiac Surgery
Sungmin Suh1, Sarah Soh2, Jae-Kwang Shim2
1Department of Anesthesiology and Pain Medicine, Soonchunhyang University College of Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea.
Objectives:
Patients undergoing cardiac surgery are at a high risk of developing postoperative delirium (POD), which is associated with increased morbidity and mortality. Neurofilament light chain (NFL), a neuronal cytoplasmic protein, is a marker of axonal injury. We investigated the association between perioperative plasma NFL concentration and POD.
Design:
A prospective observational study.
Setting:
A single institution of a tertiary university hospital PARTICIPANTS: A total of 151 patients aged ≥65 years scheduled for elective cardiac surgery with cardiopulmonary bypass.
Intervention:
Plasma NFL levels were measured at induction and 6 hours postoperatively. POD was assessed twice daily for 7 days using the Confusion Assessment Method for the ICU or 3-Minute Diagnostic Interview for CAM-defined Delirium depending on intubation. The NFL values were log-transformed. Logistic regression was used to evaluate their associations with POD. Multivariable models were adjusted for preoperative and intraoperative variables.
Measurements And Main Results:
Delirium occurred in 60 (40%) patients. Compared with those without POD, affected patients had higher rates of congestive heart failure, a lower educational status, and a higher incidence of erythrocyte transfusion. Delirium was also associated with complex procedures, prolonged deep anesthesia, and intraoperative burst suppression. Both baseline and postoperative log(NFL) were significantly associated with delirium, whereas perioperative changes in NFL were not. In the multivariable analysis, baseline log(NFL) remained an independent predictor of POD.
Conclusions:
Preoperative plasma NFL concentration was associated with POD, whereas changes in NFL were not. Baseline NFL may serve as a clinically useful biomarker for risk stratification in older patients undergoing cardiac surgery.
