Post-operative delirium associated with metabolic alterations following hemi-arthroplasty in older patients
File(s)
Author(s)
Type
Journal Article
Abstract
Background
post-operative delirium (POD) is a common complication in older patients, though a possible link between metabolic changes and POD development has yet to be investigated.
Methods
older patients with hip fracture who underwent hemi-arthroplasty were recruited, and delirious states were assessed for 3 days after surgery using the confusion assessment method-Chinese revision. Simultaneously, fasting blood samples were collected on the morning of surgery and on the first post-operative day. Ultimately, 244 older patients who met the inclusion and exclusion criteria were assessed. Blood samples from 60 patients with POD and 60 matched controls were analysed using metabolomics platforms.
Results
sixty patients (24.6%) developed POD. Principal component analysis scores plot and cross-validated scores plots from orthogonal partial least squares-discriminant analysis were implemented to visualise the differences in metabolites between the two groups before and after surgery (P < 0.05). Our data indicate that levels of ω3 and ω6 fatty acids were lower in the POD group than in the NPOD (non-POD) group both before and after surgery; tricarboxylic cycle intermediate levels were lower in the POD group than in the NPOD group, but glycolysis products were higher in the POD group than in the NPOD group after surgery. Furthermore, the branched-chain amino acid (BCAA)/aromatic amino acid ratio was lower in the POD group than in the NPOD group after surgery.
Conclusions
metabolic abnormalities, including deficiencies in ω3 and ω6 fatty acids, perturbations in tricarboxylic cycle and oxidative stress and metabolic imbalances in BCAA and AAA might contribute to POD development.
post-operative delirium (POD) is a common complication in older patients, though a possible link between metabolic changes and POD development has yet to be investigated.
Methods
older patients with hip fracture who underwent hemi-arthroplasty were recruited, and delirious states were assessed for 3 days after surgery using the confusion assessment method-Chinese revision. Simultaneously, fasting blood samples were collected on the morning of surgery and on the first post-operative day. Ultimately, 244 older patients who met the inclusion and exclusion criteria were assessed. Blood samples from 60 patients with POD and 60 matched controls were analysed using metabolomics platforms.
Results
sixty patients (24.6%) developed POD. Principal component analysis scores plot and cross-validated scores plots from orthogonal partial least squares-discriminant analysis were implemented to visualise the differences in metabolites between the two groups before and after surgery (P < 0.05). Our data indicate that levels of ω3 and ω6 fatty acids were lower in the POD group than in the NPOD (non-POD) group both before and after surgery; tricarboxylic cycle intermediate levels were lower in the POD group than in the NPOD group, but glycolysis products were higher in the POD group than in the NPOD group after surgery. Furthermore, the branched-chain amino acid (BCAA)/aromatic amino acid ratio was lower in the POD group than in the NPOD group after surgery.
Conclusions
metabolic abnormalities, including deficiencies in ω3 and ω6 fatty acids, perturbations in tricarboxylic cycle and oxidative stress and metabolic imbalances in BCAA and AAA might contribute to POD development.
Date Issued
2020-01-01
Date Acceptance
2019-10-02
Citation
Age and Ageing, 2020, 49 (1), pp.88-95
ISSN
0002-0729
Publisher
British Geriatrics Society
Start Page
88
End Page
95
Journal / Book Title
Age and Ageing
Volume
49
Issue
1
Copyright Statement
© The Author(s) 2019. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.
This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model). This is a pre-copy-editing, author-produced version of an article accepted for publication in Age and Ageing following peer review. The definitive publisher-authenticated version Yong Guo, Yingchuan Li, Yinan Zhang, Shudong Fang, Xiaotao Xu, Aihua Zhao, Junfeng Zhang, Jia V Li, Daqing Ma, Wei Jia, Wei Jiang, Post-operative delirium associated with metabolic alterations following hemi-arthroplasty in older patients, Age and Ageing, Volume 49, Issue 1, January 2020, Pages 88–95 is available online at: https://doi.org/10.1093/ageing/afz132
This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model). This is a pre-copy-editing, author-produced version of an article accepted for publication in Age and Ageing following peer review. The definitive publisher-authenticated version Yong Guo, Yingchuan Li, Yinan Zhang, Shudong Fang, Xiaotao Xu, Aihua Zhao, Junfeng Zhang, Jia V Li, Daqing Ma, Wei Jia, Wei Jiang, Post-operative delirium associated with metabolic alterations following hemi-arthroplasty in older patients, Age and Ageing, Volume 49, Issue 1, January 2020, Pages 88–95 is available online at: https://doi.org/10.1093/ageing/afz132
Sponsor
Medical Research Council (MRC)
Commission of the European Communities
Identifier
http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000518555200017&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
Grant Number
MR/P002536/1
715662
Subjects
Science & Technology
Life Sciences & Biomedicine
Geriatrics & Gerontology
post-operative delirium
hip fracture
older patients
metabolomics
POLYUNSATURATED FATTY-ACIDS
FAILURE
Publication Status
Published
Date Publish Online
2019-11-11