Preoperative homocysteine modifies the association between postoperative C-reactive protein and postoperative delirium

Xin Ma; Xinchun Mei; Tianyi Tang; Meijuan Wang; Xiaoyi Wei; Hailin Zheng; Jing Cao; Hui Zheng; Kathryn Cody; Lize Xiong; Edward R Marcantonio; Zhongcong Xie; Yuan Shen

doi:10.3389/fnagi.2022.963421

Preoperative homocysteine modifies the association between postoperative C-reactive protein and postoperative delirium

Front Aging Neurosci. 2022 Sep 21:14:963421. doi: 10.3389/fnagi.2022.963421. eCollection 2022.

Authors

Xin Ma^{1

2}, Xinchun Mei^{1

2}, Tianyi Tang^{1

2}, Meijuan Wang¹, Xiaoyi Wei^{1

2}, Hailin Zheng^{1

2}, Jing Cao², Hui Zheng³, Kathryn Cody⁴, Lize Xiong⁵, Edward R Marcantonio⁶, Zhongcong Xie⁷, Yuan Shen^{2

8}

Affiliations

¹ Department of Psychiatry, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
² Anesthesia and Brain Research Institute, Tongji University School of Medicine, Shanghai, China.
³ Massachusetts General Hospital Biostatistics Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States.
⁴ Anesthesia Research Center, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States.
⁵ Department of Anesthesiology and Translational Research Institute of Brain and Brain-Like Intelligence, Shanghai Fourth People's Hospital of Tongji University School of Medicine, Shanghai, China.
⁶ Divisions of General Medicine and Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States.
⁷ Geriatric Anesthesia Research Unit, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, United States.
⁸ Shanghai Mental Health Center of Shanghai Jiao Tong University, Shanghai, China.

Abstract

Background: Homocysteine and C-reactive protein (CRP) may serve as biomarkers of postoperative delirium. We set out to compare the role of blood concentration of homocysteine versus CRP in predicting postoperative delirium in patients.

Materials and methods: In this prospective observational cohort study, the plasma concentration of preoperative homocysteine and postoperative CRP was measured. Delirium incidence and severity within 3 days postoperatively were determined using the Confusion Assessment Method and Confusion Assessment Method-Severity algorithm.

Results: Of 143 participants [69% female, median (interquartile range, 25th-75th) age of 71 (67-76) years] who had knee or hip surgery under general anesthesia, 44 (31%) participants developed postoperative delirium. Postoperative plasma concentration of CRP was associated with postoperative delirium incidence [adjusted odds ratio (OR) per one standard deviation change in CRP: 1.51; 95% Confidence Interval (CI): 1.05, 2.16; P = 0.026], and severity [in which each one standard deviation increase in postoperative CRP was associated with a 0.47 point (95% CI: 0.18-0.76) increase in the severity of delirium, P = 0.002] after adjusting age, sex, preoperative Mini-Mental State Examination score and the days when postoperative CRP was measured. A statistically significant interaction (adjusted P = 0.044) was also observed, in which the association between postoperative plasma concentration of CRP and postoperative delirium incidence was stronger in the participants with lower preoperative plasma concentrations of homocysteine compared to those with higher preoperative levels.

Conclusion: Pending validation studies, these data suggest that preoperative plasma concentration of homocysteine modifies the established association between postoperative plasma concentration of CRP and postoperative delirium incidence.

Keywords: C-reactive protein; anesthesia; homocysteine; postoperative delirium; surgery.