Association between preoperative serum homocysteine and delayed neurocognitive recovery after non-cardiac surgery in elderly patients: a prospective observational study

Perioperative Medicine

Yuan Han¹  Liu Han²  Ke Ding²  Jun-Li Cao³  Meng-Meng Dong³  Yi-Fan Xu⁴  Zhen-Feng Zhang⁴  Qing-Chun Sun⁴ 

[1] Department of Anesthesiology, Eye & ENT Hospital of Fudan University, 83 Fenyang Road, 200031, Shanghai, China;Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, NO. 209 Tongshan Road, Yunlong District, 221004, Xuzhou City, Jiangsu Province, China;Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, NO. 209 Tongshan Road, Yunlong District, 221004, Xuzhou City, Jiangsu Province, China;Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, NO. 99 Huaihai Road, Quanshan District, 221002, Xuzhou City, Jiangsu Province, China;Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, NO. 209 Tongshan Road, Yunlong District, 221004, Xuzhou City, Jiangsu Province, China;Department of Anesthesiology, The First Affiliated Hospital with Nanjing Medical University, 210000, Nanjing City, Jiangsu Province, China;

关键词: Neurocognitive;    Nutrition;    Delayed neurocognitive recovery: risk factors;   

DOI  :  10.1186/s13741-021-00208-1

来源: Springer

【 摘 要 】

BackgroundHomocysteine, folate, and vitamin B12 involved in 1-carbon metabolism are associated with cognitive disorders. We sought to investigate the relationships between these factors and delayed neurocognitive recovery (dNCR) after non-cardiac surgery.MethodsThis was a prospective observational study of patients (n = 175) who were ≥ 60 years of age undergoing non-cardiac surgery. Patients were evaluated preoperatively and for 1 week postoperatively by using neuropsychological tests and were divided into dNCR or non-dNCR groups according to a Z-score ≤ − 1.96 on at least two of the tests. The relationship between the occurrence of dNCR and preoperative levels of homocysteine, folate, and vitamin B12 was analyzed. Univariate and multivariable logistic regression analyses were conducted to identify factors associated with dNCR.ResultsDelayed neurocognitive recovery was observed in 36 of 175 patients (20.6%; 95% confidence interval [CI], 14.5–26.6%) 1 week postoperatively. Patients who developed dNCR had significantly higher median [interquartile range (IQR)] homocysteine concentrations (12.8 [10.9,14.4] μmol/L vs 10.6 [8.6,14.7] μmol/L; P = 0.02) and lower folate concentrations (5.3 [4.2,7.3] ng/mL vs 6.9 [5.3,9.5] ng/mL; P = 0.01) than those without dNCR. Compared to the lowest tertile, the highest homocysteine tertile predicted dNCR onset (odds ratio [OR], 3.9; 95% CI, 1. 3 to 11.6; P = 0.02), even after adjusting for age, sex, education, and baseline Mini Mental State Examination.ConclusionsElderly patients with high homocysteine levels who underwent general anesthesia for non-cardiac surgery have an increased risk of dNCR. This knowledge could potentially assist in the development of preventative and/or therapeutic measures.Trial registrationNCT03084393 (https://www.clinicaltrials.gov)

【 授权许可】

CC BY