Elevated Plasma Amyloid-β 1-40 Linked to Higher Postoperative Delirium Risk After Cardiac Surgery
核心洞察
A prospective German cohort study (FINDERI) found elevated preoperative plasma amyloid-β 1-40 (搜索) levels are associated with a higher risk of postoperative delirium (搜索) after cardiac surgery.
Among 491 patients who completed delirium assessment, 106 (21.6%) developed postoperative delirium (搜索), with amyloid-β 1-40 (搜索) emerging as the strongest independent biomarker (AUC 0.65, p<0.001).
Combining amyloid-β biomarkers with clinical factors and cognitive scores improved delirium risk estimation to an AUC of 0.77, driven primarily by amyloid-β 1-40 (搜索).
Elevated preoperative plasma amyloid-β 1-40 (搜索) levels are associated with a higher risk of postoperative delirium (搜索) after cardiac surgery, according to a prospective German cohort study, offering a potential new biomarker for identifying high-risk older patients before surgery.
FINDERI Cohort Study Design
Researchers conducted a prospective observational cohort study, FINDERI, including patients aged 50 years or older undergoing elective cardiac surgery at a comprehensive cardiac surgery centre in Germany between February 2021 and October 2022. Preoperative plasma concentrations of amyloid-β 1-40 (搜索), amyloid-β 1-42 (搜索), phosphorylated tau 181 (搜索), and phosphorylated tau 217 (搜索) were measured using validated immunoassays.
The primary outcome was postoperative delirium (搜索), assessed daily for five days after surgery using the Confusion Assessment Method, with baseline cognitive function assessed using the Montreal Cognitive Assessment.
Amyloid-β 1-40 Emerged as the Strongest Biomarker for Delirium Risk
Of 504 enrolled patients, 491 completed delirium assessment (mean age 68.4 years; 78.4% male), of whom 106 (21.6%) developed postoperative delirium (搜索). Patients who developed delirium had higher preoperative amyloid-β 1-40 (搜索), amyloid-β 1-42 (搜索), and phosphorylated tau 217 (搜索) levels, and lower amyloid-β 1-42/1-40 ratios.
Amyloid-β 1-40 (搜索) was the biomarker most strongly and independently associated with delirium (area under the receiver operating curve [AUC] 0.65, 95% CI 0.59 to 0.71, p<0.001).
Combining biomarkers with clinical factors improved risk estimation (AUC 0.74, 95% CI 0.69 to 0.79, p<0.001) compared with clinical factors alone (AUC 0.73, 95% CI 0.67 to 0.78, p<0.001), and a combined model including cognitive assessment scores achieved an AUC of 0.77 (95% CI 0.72 to 0.82, p<0.001), driven primarily by amyloid-β 1-40 (搜索).
Implications for Preoperative Delirium Risk Stratification
These findings have suggested that preoperative plasma amyloid-β 1-40 (搜索) may serve as a modest but independent risk factor for postoperative delirium (搜索) in older patients undergoing cardiac surgery. As this was an observational cohort study, causality cannot be established.
The authors have suggested that amyloid-β 1-40 (搜索) could contribute to future multimodal risk stratification for delirium, though further research is needed to validate these findings.