Journal of Shandong University (Health Sciences) ›› 2021, Vol. 59 ›› Issue (3): 92-97.doi: 10.6040/j.issn.1671-7554.0.2020.1502

Previous Articles     Next Articles

Correlation analysis of acetylcholinesterase activity and inflammatory factors of 45 elderly patients with postoperative delirium

XING Zhiqun, LI Dejun, ZHAO Bao, XU Chunyang, JI Hongsheng   

  1. Department Ⅲ of Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong, China
  • Published:2021-04-06

PDF (PC)

374

Abstract: Objective To analyze the relationship among plasma acetylcholinesterase activity, inflammatory factors and postoperative delirium in patients who underwent noncardiac surgery. Methods A total of 106 patients transferred to SICU after non-cardiac surgery under general anesthesia during Oct. 2016 and Dec. 2017 were divided into the postoperative delirium group(n=45, case group)and control group(n=61). Delirium was assessed twice daily with the Confusion Assessment Method-Intensive Care Unit(CAM-ICU). The relationship among postoperative delirium, acetylcholinesterase activity and inflammatory factors such as leukocytes procalcitonin(PCT), C-reactive protein(CRP), IL-1β and IL-6 were analyzed. Results There were no statistical difference in baseline data between the two groups, while the APACHE Ⅱ score, PCT, acetylcholinesterase activity and IL-1β were statistically different(P<0.05). Binary Logistic analysis revealed that APACHE Ⅱ score(OR=1.131, 95%CI: 1.011-1.268, P=0.032), and IL-1β (OR=4.209, 95%CI: 1.528-11.592, P=0.005)were independent risk factors of postoperative delirium, while increased acetylcholinesterase activity(OR=0.678, 95%CI: 0.519-0.886, P=0.004)was a protective factor. Conclusion Postoperative delirium in elderly patients is closely related to the severity of disease. IL-1β and decreased acetylcholinesterase activity are independent risk factors of postoperative delirium. Treatment of inflammation and improvement of acetylcholinesterase activity are beneficial to prevent or reduce the occurrence of postoperative delirium, which provides a new idea for the clinical diagnosis and treatment strategies.

Key words: Postoperative delirium, Elderly patients, Acetylcholinesterase activity, Inflammatory factors

CLC Number: 

  • R747.9
[1] Numan T, van den Boogaard M, Kamper AM, et al. Recognition of delirium in postoperative elderly patients: a multicenter study [J]. J Am Geriatr Soc, 2017, 65(9): 1932-1938.
[2] Schenning KJ, Deiner SG. Postoperative delirium in the geriatric patient [J]. Anesthesiol Clin, 2015, 33(3): 505-516.
[3] Girard TD, Jackson JC, Pandharipande PP, et al. Delirium as a predictor of long-term cognitive impairment in survivors of critical illness [J]. Crit Care Med, 2010, 38(7): 1513-1520.
[4] Yang Y, Zhao X, Dong T, et al. Risk factors for postoperative delirium following hip fracture repair in elderly patients: a systematic review and meta-analysis [J]. Aging Clin Exp Res, 2017, 29(2): 115-126.
[5] Su X, Meng ZT, Wu XH, et al. Dexmedetomidine for prevention of delirium in elderly patients after non-cardiac surgery: a randomised, double-blind, placebo-controlled trial [J]. Lancet, 2016, 388(10054): 1893-1902.
[6] Emam SJ, O'Mahony MS, El Khatieb M, et al. Influenza vaccination and the activities of plasma acetylcholinesterase and butyrylcholinesterase in institutionalised elderly patients [J]. Arch Gerontol Geriatr, 1998, 27(2): 179-185.
[7] Cerejeira J, Batista P, Nogueira V, et al. Low preoperative plasma cholinesterase activity as a risk marker of postoperative delirium in elderly patients [J]. Age Ageing, 2011, 40(5): 621-626.
[8] John M, Ely EW, Halfkann D, et al. Acetylcholinesterase and butyrylcholinesterase in cardiosurgical patients with postoperative delirium [J]. J Intensive Care, 2017, 5: 29. doi: 10.1186/s40560-017-0224-1.
[9] 顾冰, 王伟, 连蕊, 等. 血清丁酰胆碱酯酶活性与急性心肌梗死患者经皮冠状动脉介入治疗术后炎症因子及短期预后的相关性[J]. 临床内科杂志, 2019, 36(6): 394-398. GU Bing, WANG Wei, LIAN Rui, et al. Correlation between serum butyrylcholinesterase activity with inflammatory factors and short-term prognosis in patients with acute myocardial infarction after percutaneous coronary intervention[J]. Journal of Chinical Internal Medicine, 2019, 36(6): 394-398.
[10] Spiegel DR, Chen V. A case of postoperative cognitive decline, with a highly elevated C- reactive protein, status post left ventricular assist device insertion: a review of the neuroinflammatory hypothesis of delirium [J]. Innov Clin Neurosci, 2012, 9(1): 35-41.
[11] Wilson CJ, Finch CE, Cohen HJ. Cytokines and cognition - the case for a head-to-toe inflammatory paradigm [J]. J Am Geriatr Soc, 2002, 50(12): 2041-2056.
[12] Maclullich AM, Ferguson KJ, Miller T, et al. Unravelling the pathophysiology of delirium: a focus on the role of aberrant stress responses [J]. J Psychosom Res, 2008, 65(3): 229-238.
[13] Capri M, Yani SL, Chattat R, et al. Pre-Operative, High-IL-6 Blood Level is a Risk Factor of Post-Operative Delirium Onset in Old Patients [J]. Front Endocrinol(Lausanne), 2014, 5: 173. doi: 10.3389/fendo.2014.00173.
[14] Zhang W, Wang T, Wang G, et al. Effects of Dexmedetomidine on Postoperative Delirium and Expression of IL-1β, IL-6, and TNF-α in Elderly Patients After Hip Fracture Operation [J]. Front Pharmacol, 2020, 11: 678. doi: 10.3389/fphar.2020.00678.
[15] 冷凌涵. 血清PCT对住院危重患者谵妄发病的预测效果分析[J]. 贵州医药, 2019, 43(10): 1616-1617.
[16] Sankar A, Johnson SR, Beattie WS, et al. Reliability of the American Society of Anesthesiologists physical status scale in clinical practice [J]. Br J Anaesth, 2014, 113(3): 424-432.
[17] Sessler CN, Gosnell MS, Grap MJ, et al. The Richmond Agitation-Sedation Scale: validity and reliability in adult intensive care unit patients [J]. Am J Respir Crit Care Med, 2002, 166(10): 1338-1344.
[18] Han JH, Vasilevskis EE, Chandrasekhar R, et al. Delirium in the emergency department and its extension into hospitalization(DELINEATE)study: effect on 6-month function and cognition [J]. J Am Geriatr Soc, 2017, 65(6): 1333-1338.
[19] González M, Martínez G, Calderón J, et al. Impact of delirium on short-term mortality in elderly inpatients: a prospective cohort study [J]. Psychosomatics, 2009, 50(3): 234-238.
[20] Hughes CG, Morandi A, Girard TD, et al. Association between endothelial dysfunction and acute brain dysfunction during critical illness [J]. Anesthesiology, 2013, 118(3): 631-639.
[21] Alexander SA, Ren D, Gunn SR, et al. Interleukin 6 and apolipoprotein E as predictors of acute brain dysfunction and survival in critical care patients [J]. Am J Crit Care, 2014, 23(1): 49-57.
[22] Ritter C, Tomasi CD, Dal-Pizzol F, et al. Inflammation biomarkers and delirium in critically ill patients [J]. Crit Care,2014, 18(3): R106.
[23] van Gool WA, van de Beek D, Eikelenboom P. Systemic infection and delirium: when cytokines and acetylcholine collide [J]. Lancet, 2010, 375(9716): 773-775.
[24] McNeil JB, Hughes CG, Girard T, et al. Plasma biomarkers of inflammation, coagulation, and brain injury as predictors of delirium duration in older hospitalized patients [J]. PLoS One, 2019, 14(12): e 0226412. doi: 10.1371/journal.pone.0226412.
[25] 章娅妮, 黄桔秀, 朱海勇, 等. 降钙素原与乳酸和C-反应蛋白检测在感染性休克中意义及对预后评估价值分析[J]. 中华医院感染学杂志, 2018, 28(6): 841-843. ZHANG Yani, HUANG Juxiu, ZHU Haiyong, et al. Significance of procalcitonin, lactic acid and C reactive protein detection in septic shock and its prognostic value [J]. Chinese Journal of Nosocomiology, 2018, 28(6): 841-843.
[26] Sproston NR, Ashworth JJ. Role of C-reactive protein at sites of inflammation and infection [J]. Front Immunol, 2018, 9: 754. doi: 10.3389/fimmu.2018.00754.
[27] Dillon ST, Vasunilashorn SM, Ngo L, et al. Higher C-reactive protein levels predict postoperative delirium in older patients undergoing major elective surgery: a longitudinal nested case-control study [J]. Biol Psychiatry, 2017, 81(2): 145-153.
[28] Vijayan AL, Vanimaya, Ravindran S, et al. Procalcitonin: a promising diagnostic marker for sepsis and antibiotic therapy [J]. J Intensive Care, 2017, 5: 51. doi: 10.1186/s40560-017-0246-8.
[29] Cancelli I, Beltrame M, Gigli GL, et al. Drugs with anticholinergic properties: cognitive and neuropsychiatric side-effects in elderly patients [J]. Neurol Sci, 2009, 30(2): 87-92.
[30] Tracey KJ. Physiology and immunology of the cholinergic antiinflammatory pathway [J]. J Clin Invest, 2007, 117(2): 289-296.
[1] DONG Xiaoqian, LI Guanjiang, XU Qianqian, XU Hongwei. Comparison among ERCP combined with ursodeoxycholic acid and other therapies in the treatment of choledocholithiasis complicated with cholecystolithiasis [J]. Journal of Shandong University (Health Sciences), 2022, 60(5): 59-66.
[2] SUN Jiye, WANG Ziou, SUN Xiaowei, LI Hongtao. Effects of traditional Chinese medicine fumigation combined with extracorporeal shock wave therapy on 72 cases of femoroacetabular impingement syndrome and serum inflammatory factor [J]. Journal of Shandong University (Health Sciences), 2022, 60(4): 76-81.
[3] ZHANG Mingming, GAO Wei, CUI Jia, HUO Lijing, HU Qingchuan, LI Weihao, WANG Chao. Expression and significance of serum miR-33a in patients with stable angina pectoris [J]. Journal of Shandong University (Health Sciences), 2021, 59(6): 64-70.
[4] YU Xueyuan, ZHANG Shuo, YAN Fangfang, SU Dezhen. Comparison of clinical efficacy of Qingfei Paidu decoction combined with western medicine in 43 cases and single western medicine in 46 cases in the treatment of COVID-19 [J]. Journal of Shandong University (Health Sciences), 2020, 58(12): 47-53.
[5] YANG Zhangjie, WANG Yuxin, CHEN Dongmei, ZHAO Shuai, HU Na, MA Lianghong, MA Huiming. Effects of Lycium barbarum seed oil(LBSO)on anti-inflammation in the aging Sertoli cells of mice(TM4 cells) [J]. Journal of Shandong University (Health Sciences), 2020, 58(12): 15-22.
[6] GENG Erdong, NING Juan. Efficacy of atenolol on the treatment of acute coronary syndrome complicated with arrhythmia and the prognosis [J]. Journal of Shandong University (Health Sciences), 2018, 56(5): 70-73.
[7] YAN Songhe, GAO Lifen, ZHAO Wei, WANG Yan. Inhibition of human apical papilla cells on the activation of mononuclear cell THP-1 and its molecular mechanism [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2017, 55(3): 49-53.
[8] YANG Shengsi, CHENG Yufeng. Application of Onodera prognostic nutrition index in elderly patients with esophageal carcinoma treated with radiotherapy [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2015, 53(6): 54-57.
[9] PAN Guozheng, YOU Faping, WANG Shuai, BU Qing'ao, YUAN Qingzhong. Effect of goal-directed fluid therapy on abdominal surgery in elderly patients [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2015, 53(6): 82-85.
[10] ZHU Lei, ZHAO Zhibin, FENG Jiying, ZHU Pin, LUAN Hengfei, ZHANG Xiaobao. Role of ultrasound guided measurement of inferior vena cava and right ventricular diameters in the assessment of volume status in elderly patients [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2014, 52(10): 96-99.
[11] HOU Yun-feng1，2, BU Pei-li1. Change of serum heat shock protein 70 in the MODS patients and its clinical significance [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2013, 51(06): 63-70.
[12] CAO Li-jun1, WANG Jin2, SUN Chun-li1, CHEN Yu-guo1. Mechanism and protective effect of ulinastatin on synaptic function of
hippocampus after focal brain ischemiareperfusion injury in rats [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2012, 50(2): 6-.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
[1] WANG Huan-liang,SUN Bao-zhu,DU Hong-mei,ZHOU Chang-qing,ZHANG Li. Controlling the depth of propofol anesthesia using the bispectral indexand the systolic blood pressure[J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2006, 44(5): 471 -474 .
[2] YU Hui1,2, CHEN Shaohua1, ZHAO Jiajun2, GAO Ling3
. Effects of ethanol on glycogen content, GSK3β，
and PAMPK of L02 cells[J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2009, 47(04): 75 -78 .
[3] HUANGQing,TIAN Hui,LI Lin,LIANG Fei,LIU Xi-xian. [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2006, 44(6): 556 -559 .
[4] ZHU Mei-jia,HAN Ju,WANG Xin-yi,LU Wei,WANG Ai-hua,GUAN Xin-hua,CAO Xia,CAO Bing-zhen. [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2006, 44(8): 834 -839 .
[5] SONG Yong-hong,MA Chun-hong,LV Hong-juan,ZHU Chuan-fu,NIE Xiang-min,WANG Mei,LIU Yan,ZHANG Ping. HLA allele polymorphism in northern Hans of China[J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2007, 45(6): 546 -553 .
[6] ZENG Ji-ping,WANG Li-na,WANG Li-xiang,REN Xiao-hui,ZHANG Meng-ye,XIA Wen,CUI Xing. [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2006, 44(5): 467 -470 .
[7] SHU Ya,QI Feng. Jaw thrust device (JTD) on obesity patients for maintaining the airway patency during general anesthesia induction[J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2007, 45(10): 1072 -1074 .
[8] SONG Hai-yan, WU Yu-ling, ZHANG Yan-ping. Protective effect of oyster extract on apoptotic cells in neural tube defect induced by hyperthermia[J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2007, 45(2): 113 -116 .
[9] WANG Zhi-ang,DING Xua,SUN Peng/sup>,WANG Cheng-wei,HAO Xiao-guang,PAN Shun. Role of pre-operative cerebral angiography in cerebral artery stenosis stent angioplasty[J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2007, 45(2): 146 -148 .
[10] HOU Xiao-yang,BU Pei-li,ZHANG Yun,FENG Jin-bo,LIU Chun-xi,LI Chuan-bao,HAO Ming-xiu. Peroxisome proliferatorsactivated receptor α play a critical role in the inhibition of myocardial fibrosis induced by AngⅡ in vitro[J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2007, 45(7): 665 -668 .
Copyright 2018 © Editorial office of Journal of Shandong University (Health Sciences)
Supported by Beijing Magtech Co.Ltd