Journal of Cardiothoracic and Vascula Anesthesia | May 16, 2021

Wiberg S, Holmgaard F, Zetterberg H, Nilsson J-C, Kjaergaard J, Wanscher M, Langkilde AR, Hassager C, Rasmussen LS, Blennow K and Vedel AG

Journal of Cardiothoracic and Vascular Anesthesia. 2021

DOI: https://doi.org/10.1053/j.jvca.2021.05.016

Abstract

Objectives

: To assess the ability of the biomarkers neuron-specific enolase (NSE), tau, neurofilament light chain (NFL), and glial fibrillary acidic protein (GFAP) to predict POCD at discharge in cardiac surgery patients.

Design

: Post-hoc analyses (with tests being pre-specified prior to data analyses) from a randomized clinical trial.

Setting

: Single center study from a primary heart center in Denmark.

Participants

: Adult patients undergoing elective or subacute on-pump coronary artery bypass grafting and/or aortic valve replacement.

Interventions

: Blood was collected prior to induction of anesthesia, after 24 hours, after 48 hours, and at discharge from the surgical department. The ISPOCD test battery was applied to diagnose POCD at discharge and after 3 months. Linear mixed models of covariance were used to assess whether repeated measurements of biomarker levels were associated with POCD. Receiver operating characteristics (ROC) curves were applied to assess the predictive value of each biomarker measurement for POCD.

Measurements & Main Results

: A total of 168 patients had biomarkers measured at baseline, and 47 (28%) fulfilled the POCD criteria at discharge. Patients with POCD at discharge had significantly higher levels of tau (p = 0.02) and GFAP (p = 0.01) from baseline to discharge. The biomarker measurements achieving the highest area under the ROC curve for prediction of POCD at discharge were NFL measured at discharge (AUC 0.64; 95%CI 0.54-0.73), GFAP measured 48 hours after induction (AUC 0.64; 95%CI 0.55-0.73), and GFAP measured at discharge (AUC 0.64; 95%CI 0.54-0.74), corresponding to a moderate predictive ability.

Conclusions

: Postoperative serum levels of tau and GFAP were significantly elevated in cardiac surgery patients with POCD at discharge, however, the biomarkers achieved only modest predictive abilities for POCD at discharge. Postoperative levels of NSE were not associated with POCD at discharge.