Urinary albumin creatinine ratio associated with postoperative delirium in elderly patients undergoing elective non-cardiac surgery: A prospective observational study

Hui-Lian Guan; He Liu; Xiao-Yi Hu; Mannan Abdul; Ming-Sheng Dai; Xing Gao; Xue-Fen Chen; Yang Zhou; Xun Sun; Jian Zhou; Xiang Li; Qiu Zhao; Qian-Qian Zhang; Jun Wang; Yuan Han; Jun-Li Cao

doi:10.1111/cns.13717

Urinary albumin creatinine ratio associated with postoperative delirium in elderly patients undergoing elective non-cardiac surgery: A prospective observational study

CNS Neurosci Ther. 2022 Apr;28(4):521-530. doi: 10.1111/cns.13717. Epub 2021 Aug 20.

Authors

Hui-Lian Guan^{1

2

3}, He Liu⁴, Xiao-Yi Hu^{1

2}, Mannan Abdul^{1

2}, Ming-Sheng Dai^{1

2}, Xing Gao^{1

2}, Xue-Fen Chen⁵, Yang Zhou^{1

2}, Xun Sun^{1

2}, Jian Zhou^{1

2}, Xiang Li^{1

2}, Qiu Zhao^{1

2}, Qian-Qian Zhang^{1

2}, Jun Wang^{1

2}, Yuan Han⁶, Jun-Li Cao^{1

2}

Affiliations

¹ Jiangsu Province Key Laboratory of Anesthesiology & NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou City, China.
² Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou City, China.
³ Department of Anesthesiology, The First Affiliated Hospital of Bengbu Medical College, Bengbu City, China.
⁴ Department of Anesthesiology, The Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Huzhou Central Hospital, Huzhou City, China.
⁵ School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
⁶ Department of Anesthesiology, Eye & ENT Hospital of Fudan University, Shanghai, China.

Abstract

Introduction: The blood-brain barrier (BBB) disruption contributes to postoperative delirium, but cost-effective and non-invasive assessment of its permeability is not practicable in the clinical settings. Urine albumin to creatinine ratio (UACR), reflecting systemic vascular endothelial dysfunction, may be a prognostic and predictive factor associated with postoperative delirium. The aim was to analyze the relationship between UACR and postoperative delirium in elderly patients undergoing elective non-cardiac surgery.

Materials and methods: Through stratified random sampling, a cohort of 408 individuals aged 60 years and older scheduled for elective non-cardiac surgery were included between February and August 2019 in the single-center, prospective, observational study. The presence of delirium was assessed using the Confusion Assessment Method (CAM) or Confusion Assessment Method for the ICU (CAM-ICU) on the day of surgery, at 2 h after the surgery ending time and on the first 3 consecutive days with repeated twice-daily, with at least 6-h intervals between assessments. Urine samples were collected on one day before surgery, and 1st day and 3rd day after surgery. The primary outcome was the presence of postoperative delirium, and association of the level of UACR with postoperative delirium was evaluated with unadjusted/adjusted analyses and multivariable logistic regression.

Results: Postoperative delirium was observed in 26.75% (107 of 400) of patients within 3 days post-surgery. UACR-Pre (OR, 1.30; 95% CI, 1.14-1.49, p < 0.001), UACR-POD1 (OR, 1.20; 95% CI, 1.13-1.27, p < 0.001), and UACR-POD3 (OR, 1.14; 95% CI, 1.08-1.20, p < 0.001) between the delirium and non-delirium groups show a significant difference, even after adjusting for age, education levels, and other factors.

Conclusion: As the marker of endothelial dysfunction, the high perioperative UACR value may be linked to the postoperative delirium in elderly patients undergoing elective non-cardiac surgery.

Keywords: delirium; elderly patient; the blood-brain barrier; urinary albumin creatinine ratio.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Albumins
Creatinine
Delirium* / diagnosis
Delirium* / etiology
Humans
Middle Aged
Postoperative Complications* / diagnosis
Prospective Studies
Risk Factors

Substances

Albumins
Creatinine