Immunological Analysis of Postoperative Delirium after Thoracic Aortic Surgery.

Q4 Medicine Journal of Chest Surgery Pub Date : 2024-05-05 Epub Date: 2024-03-13 DOI:10.5090/jcs.23.159
Haein Ko, Mukhammad Kayumov, Kyo Seon Lee, Sang Gi Oh, Kook Joo Na, In Seok Jeong
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Abstract

Background: Delirium is a recognized neurological complication following cardiac surgery and is associated with adverse clinical outcomes, including elevated mortality and prolonged hospitalization. While several clinical risk factors for post-cardiac surgery delirium have been identified, the pathophysiology related to the immune response remains unexamined. This study was conducted to investigate the immunological factors contributing to delirium in patients after thoracic aortic surgery.

Methods: We retrospectively evaluated 43 consecutive patients who underwent thoracic aortic surgery between July 2017 and June 2018. These patients were categorized into 2 groups: those with delirium and those without it. All clinical characteristics were compared between groups. Blood samples were collected and tested on the day of admission, as well as on postoperative days 1, 3, 7, and 30. Levels of helper T cells (CD4), cytotoxic T cells (CD8), B cells (CD19), natural killer cells (CD56+CD16++), and monocytes (CD14+CD16-) were measured using flow cytometry.

Results: The median patient age was 71 years (interquartile range, 56.7 to 79.0 years), and 21 of the patients (48.8%) were male. Preoperatively, most immune cell counts did not differ significantly between groups. However, the patients with delirium exhibited significantly higher levels of interleukin-6 and lower levels of tumor necrosis factor-alpha (TNF-α) than those without delirium (p<0.05). Multivariate analysis revealed that lower TNF-α levels were associated with an increased risk of postoperative delirium (p<0.05).

Conclusion: Postoperative delirium may be linked to perioperative changes in immune cells and preoperative cytokine levels. Additional research is required to elucidate the pathophysiological mechanisms underlying delirium.

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胸主动脉手术后谵妄的免疫学分析
背景:谵妄是公认的心脏手术后神经系统并发症,与不良临床结果相关,包括死亡率升高和住院时间延长。虽然已经确定了心脏手术后谵妄的几个临床风险因素,但与免疫反应有关的病理生理学仍未得到研究。本研究旨在探讨导致胸主动脉手术后患者谵妄的免疫学因素:我们对 2017 年 7 月至 2018 年 6 月间接受胸主动脉手术的 43 名连续患者进行了回顾性评估。这些患者被分为两组:有谵妄和无谵妄的患者。两组患者的所有临床特征均进行了比较。在入院当天以及术后第 1、3、7 和 30 天采集并检测血液样本。使用流式细胞术测量辅助性 T 细胞(CD4)、细胞毒性 T 细胞(CD8)、B 细胞(CD19)、自然杀伤细胞(CD56+CD16++)和单核细胞(CD14+CD16-)的水平:患者年龄中位数为 71 岁(四分位数间距为 56.7 岁至 79.0 岁),其中 21 名患者(48.8%)为男性。术前,大多数免疫细胞计数在各组之间没有明显差异。然而,与无谵妄的患者相比,有谵妄的患者白细胞介素-6的水平明显较高,而肿瘤坏死因子-α(TNF-α)的水平较低(p结论:术后谵妄可能与围手术期免疫细胞和术前细胞因子水平的变化有关。要阐明谵妄的病理生理机制,还需要更多的研究。
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来源期刊
Journal of Chest Surgery
Journal of Chest Surgery Medicine-Surgery
CiteScore
0.80
自引率
0.00%
发文量
76
审稿时长
7 weeks
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