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

Abstract Background Homocysteine, 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. Methods This was a prospective obs...

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Autores principales:	Zhen-Feng Zhang, Qing-Chun Sun, Yi-Fan Xu, Ke Ding, Meng-Meng Dong, Liu Han, Abdul-Mannan, Yuan Han, Jun-Li Cao
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Neurocognitive Nutrition Delayed neurocognitive recovery: risk factors Surgery RD1-811
Acceso en línea:	https://doaj.org/article/d5a88f0073f3462693c3f11836bcd562
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spelling	oai:doaj.org-article:d5a88f0073f3462693c3f11836bcd5622021-11-14T12:39:07ZAssociation between preoperative serum homocysteine and delayed neurocognitive recovery after non-cardiac surgery in elderly patients: a prospective observational study10.1186/s13741-021-00208-12047-0525https://doaj.org/article/d5a88f0073f3462693c3f11836bcd5622021-11-01T00:00:00Zhttps://doi.org/10.1186/s13741-021-00208-1https://doaj.org/toc/2047-0525Abstract Background Homocysteine, 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. Methods This 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. Results Delayed 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. Conclusions Elderly 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 registration NCT03084393 ( https://www.clinicaltrials.gov )Zhen-Feng ZhangQing-Chun SunYi-Fan XuKe DingMeng-Meng DongLiu HanAbdul-MannanYuan HanJun-Li CaoBMCarticleNeurocognitiveNutritionDelayed neurocognitive recovery: risk factorsSurgeryRD1-811ENPerioperative Medicine, Vol 10, Iss 1, Pp 1-13 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Neurocognitive Nutrition Delayed neurocognitive recovery: risk factors Surgery RD1-811
spellingShingle	Neurocognitive Nutrition Delayed neurocognitive recovery: risk factors Surgery RD1-811 Zhen-Feng Zhang Qing-Chun Sun Yi-Fan Xu Ke Ding Meng-Meng Dong Liu Han Abdul-Mannan Yuan Han Jun-Li Cao Association between preoperative serum homocysteine and delayed neurocognitive recovery after non-cardiac surgery in elderly patients: a prospective observational study
description	Abstract Background Homocysteine, 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. Methods This 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. Results Delayed 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. Conclusions Elderly 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 registration NCT03084393 ( https://www.clinicaltrials.gov )
format	article
author	Zhen-Feng Zhang Qing-Chun Sun Yi-Fan Xu Ke Ding Meng-Meng Dong Liu Han Abdul-Mannan Yuan Han Jun-Li Cao
author_facet	Zhen-Feng Zhang Qing-Chun Sun Yi-Fan Xu Ke Ding Meng-Meng Dong Liu Han Abdul-Mannan Yuan Han Jun-Li Cao
author_sort	Zhen-Feng Zhang
title	Association between preoperative serum homocysteine and delayed neurocognitive recovery after non-cardiac surgery in elderly patients: a prospective observational study
title_short	Association between preoperative serum homocysteine and delayed neurocognitive recovery after non-cardiac surgery in elderly patients: a prospective observational study
title_full	Association between preoperative serum homocysteine and delayed neurocognitive recovery after non-cardiac surgery in elderly patients: a prospective observational study
title_fullStr	Association between preoperative serum homocysteine and delayed neurocognitive recovery after non-cardiac surgery in elderly patients: a prospective observational study
title_full_unstemmed	Association between preoperative serum homocysteine and delayed neurocognitive recovery after non-cardiac surgery in elderly patients: a prospective observational study
title_sort	association between preoperative serum homocysteine and delayed neurocognitive recovery after non-cardiac surgery in elderly patients: a prospective observational study
publisher	BMC
publishDate	2021
url	https://doaj.org/article/d5a88f0073f3462693c3f11836bcd562
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Association between preoperative serum homocysteine and delayed neurocognitive recovery after non-cardiac surgery in elderly patients: a prospective observational study

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