Correlation of Serum BACE1 With Emergence Delirium in Postoperative Patients: A Preliminary Study

Chunyan Ye; Yanrong Zhang; Sumei Luo; Yanan Cao; Feng Gao; E Wang

doi:10.3389/fnagi.2020.555594

Correlation of Serum BACE1 With Emergence Delirium in Postoperative Patients: A Preliminary Study

Front Aging Neurosci. 2020 Oct 28:12:555594. doi: 10.3389/fnagi.2020.555594. eCollection 2020.

Authors

Chunyan Ye¹, Yanrong Zhang¹, Sumei Luo¹, Yanan Cao¹, Feng Gao², E Wang^{1

3}

Affiliations

¹ Department of Anesthesiology, Xiangya Hospital Central South University, Changsha, China.
² Institute on Aging and Brain Disorders, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China.
³ National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), Changsha, China.

Abstract

Background: The mechanism underlying delirium, a common acute fluctuating mental state, may be related to the activation of a neuroinflammatory response. In this study, we attempted to investigate whether plasma inflammatory response markers, vascular and cerebrovascular injury-related markers, and neurodegeneration-associated markers were associated with emergence delirium (ED). Methods: Patients aged 50 years or above who underwent elective laparoscopic surgery under general anesthesia were included in this study. Delirium was assessed postoperatively with the Richmond Agitation Sedation Scale (RASS) and the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) scale. Plasma samples were collected from ED patients and non-ED patients to test concentrations of inflammation markers, including interleukin 6 (IL-6), chitinase 3-like 1 (CHI3L1), S100 calcium-binding protein B (S100B), lipoprotein-associated phospholipase-A2 (Lp-PLA2), and macrophage migration inhibitory factor (MIF); vascular and cerebrovascular injury-related markers, including intercellular cell adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule (VCAM-1); and neurodegeneration-associated markers, including alpha-synuclein (α-Syn) and β-secretase 1 (BACE1). Binary logistic regression analysis was performed to analyze the relationship between biomarkers and ED, and receiver operating characteristic (ROC) curves were used to analyze the diagnostic value of biomarkers. Results: A total of 104 patients were included in this study, with an average age of 63.69 ± 7.21. IL-6 (OR = 2.73, 95% CI: 1.66-6.44, P = 0.022), S100B (OR = 4.74, 95% CI: 1.88-11.95, P = 0.001), and BACE1 (OR = 6.54, 95% CI: 2.57-16.65, P < 0.000) were independent biological indicators for the occurrence of ED.CHI3L1, Lp-PLA2, MIF, ICAM-1, VCAM-1, and α-Syn were unrelated to ED. Plasma BACE1 level had a possible diagnostic value for ED [area under curve (AUC) = 0.75, 95% CI: 0.66-0.85], whereas plasma IL-6 (AUC = 0.62, 95% CI: 0.51-0.73) and S100B (AUC = 0.65, 95% CI: 0.54-0.76) levels had little diagnostic value for distinguishing ED vs. non-ED. Conclusion: Higher levels of systemic inflammation marker IL-6, cerebral inflammation marker S100B, and neurodegeneration-associated marker BACE1 are related to ED. Plasma BACE1 may be a potential diagnostic biomarker for ED.

Keywords: BACE1; biomarker; delirium; emergence; general anesthesia.