Association between plasma tau and postoperative delirium incidence and severity: a prospective observational study

Postoperative delirium is associated with increases in the neuronal injury biomarker, neurofilament light (NfL). Here we tested whether two other biomarkers, glial fibrillary acidic protein (GFAP) and tau, are associated with postoperative delirium. A total of 114 surgical patients were recruited in...

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Bibliographic Details
Published in:	British journal of anaesthesia : BJA Vol. 126; no. 2; p. 458
Main Authors:	Ballweg, Tyler, White, Marissa, Parker, Margaret, Casey, Cameron, Bo, Amber, Farahbakhsh, Zahra, Kayser, Austin, Blair, Alexander, Lindroth, Heidi, Pearce, Robert A, Blennow, Kaj, Zetterberg, Henrik, Lennertz, Richard, Sanders, Robert D
Format:	Journal Article
Language:	English
Published:	England 01-02-2021
Subjects:	Aged Biomarkers - blood Delirium - blood Delirium - diagnosis Delirium - epidemiology Female Glial Fibrillary Acidic Protein - blood Humans Incidence Interleukin-8 - blood Male Postoperative Complications - blood Postoperative Complications - diagnosis Postoperative Complications - epidemiology Predictive Value of Tests Prospective Studies Severity of Illness Index tau Proteins - blood Time Factors postoperative inflammation neuronal injury tau biomarker glial fibrillary acidic protein delirium surgery
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Summary:	Postoperative delirium is associated with increases in the neuronal injury biomarker, neurofilament light (NfL). Here we tested whether two other biomarkers, glial fibrillary acidic protein (GFAP) and tau, are associated with postoperative delirium. A total of 114 surgical patients were recruited into two prospective biomarker cohort studies with assessment of delirium severity and incidence. Plasma samples were sent for biomarker analysis including tau, NfL, and GFAP, and a panel of 10 cytokines. We determined a priori to adjust for interleukin-8 (IL-8), a marker of inflammation, when assessing associations between biomarkers and delirium incidence and severity. GFAP concentrations showed no relationship to delirium. The change in tau from preoperative concentrations to postoperative Day 1 was greater in patients with postoperative delirium (P<0.001) and correlated with delirium severity (ρ=0.39, P<0.001). The change in tau correlated with increases in IL-8 (P<0.001) and IL-10 (P=0.0029). Linear regression showed that the relevant clinical predictors of tau changes were age (P=0.037), prior stroke/transient ischaemic attack (P=0.001), and surgical blood loss (P<0.001). After adjusting for age, sex, preoperative cognition, and change in IL-8, tau remained significantly associated with delirium severity (P=0.026). Using linear mixed effect models, only tau (not NfL or IL-8) predicted recovery from delirium (P<0.001). The change in plasma tau was associated with delirium incidence and severity, and resolved over time in parallel with delirium features. The impact of this putative perioperative neuronal injury biomarker on long-term cognition merits further investigation. NCT02926417 and NCT03124303.
ISSN:	1471-6771
DOI:	10.1016/j.bja.2020.08.061