Association of perioperative plasma concentration of neurofilament light with delirium after cardiac surgery: a nested observational study

Charles H. Brown, Department of Anesthesiology & Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: cbrownv@jhmi.edu.
Alexander S. Kim, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Medicine, Highland Hospital-Alameda Health System, Oakland, CA, USA.
Lisa Yanek, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Alexandria Lewis, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Kaushik Mandal, Department of Surgery, Detroit Medical Center, Detroit, MI, USA.
Lan Le, Department of Anesthesiology & Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; George Washington University School of Medicine and Health Sciences, Washington DC, USA.
Jing Tian, Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA; Emergent Biosolutions Company, Gaithersburg, MD, USA.
Karin J. Neufeld, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Psychiatry and Behavioural Neurosciences, Faculty of Health Sciences, McMaster University, ON, Canada.
Charles Hogue, Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Abhay Moghekar, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Document Type

Journal Article

Publication Date

2-1-2024

Journal

British journal of anaesthesia

Volume

132

Issue

2

DOI

10.1016/j.bja.2023.10.043

Keywords

blood biomarker; cardiac surgery; geriatrics; neurofilament light; postoperative delirium

Abstract

BACKGROUND: Neurofilament light is a blood-based biomarker of neuroaxonal injury that can provide insight into perioperative brain vulnerability and injury. Prior studies have suggested that increased baseline and postoperative concentrations of neurofilament light are associated with delirium after noncardiac surgery, but results are inconsistent. Results have not been reported in cardiac surgery patients, who are among those at highest risk for delirium. We hypothesised that perioperative blood concentrations of neurofilament light (both baseline and change from baseline to postoperative day 1) are associated with delirium after cardiac surgery. METHODS: This study was nested in a trial of arterial blood pressure targeting during cardiopulmonary bypass using cerebral autoregulation metrics. Blood concentrations of neurofilament light were measured at baseline and on postoperative day 1. The primary outcome was postoperative delirium. Regression models were used to examine the associations between neurofilament light concentration and delirium and delirium severity, adjusting for age, sex, race, logistic European System for Cardiac Operative Risk Evaluation, bypass duration, and cognition. RESULTS: Delirium occurred in 44.6% of 175 patients. Baseline neurofilament light concentration was higher in delirious than in non-delirious patients (median 20.7 pg ml [IQR 16.1-33.2] vs median 15.5 pg ml [IQR 12.1-24.2], P<0.001). In adjusted models, greater baseline neurofilament light concentration was associated with delirium (odds ratio, 1.027; 95% confidence interval, 1.003-1.053; P=0.029) and delirium severity. From baseline to postoperative day 1, neurofilament light concentration increased by 42%, but there was no association with delirium. CONCLUSIONS: Baseline neurofilament light concentration, but not change from baseline to postoperative day 1, was associated with delirium after cardiac surgery.

Department

School of Medicine and Health Sciences Student Works

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