Preoperative Serum Metabolites Are Associated With Postoperative Delirium in Elderly Hip-Fracture Patients.

Journal Article (Journal Article)

BACKGROUND: Hypotheses on the development of postoperative delirium (PD) include "neuroinflammatory," "neuronal aging," "oxidative stress," "neurotransmitter deficiency," and "neuroendocrine." Here, we employed metabolomics to determine the serum metabolites in the baseline associated with an increased risk of PD. METHODS: Two hundred and nine elderly hip-fracture patients who had undergone hemiarthroplasty and had completed our assessments were selected. Fasting venous blood was collected at 7:00 on the morning of surgery and a serum sample bank was created for analysis. On the first 3 postoperative days, the patients were assessed twice daily using the Confusion Assessment Method - Chinese Revision. Ultimately, 43 patients were diagnosed with PD, who comprised the PD group. Meanwhile, 43 matched non-PD patients were selected based on age, sex, and body mass index. Serum samples from the two groups were analyzed by gas chromatography-time-of-flight mass spectrometry and Acquity ultra-performance liquid chromatography-quadrupole time-of-flight mass spectrometry. RESULTS: The demographic characteristics of the groups were matched. Four metabolites associated with an increased risk of PD were identified, including S-methylcysteine, linolenic acid, eicosapentaenoic acid, and linoleic acid. CONCLUSIONS: Multiple metabolic pathways in the PD group altered before surgery, including deficiency of ω3 and ω6 fatty acids, energy metabolism and oxidative stress with interactions between hypoxia and mitochondrial dysfunction, in addition to glutamate-glutamine cycle dysfunction. These metabolic abnormalities could possibly increase the fragility of the brain and then contribute to PD.

Full Text

Duke Authors

Cited Authors

  • Guo, Y; Zhang, Y; Jia, P; Wang, W; Zhou, Q; Sun, L; Zhao, A; Zhang, X; Wang, X; Li, Y; Zhang, J; Jiang, W

Published Date

  • November 9, 2017

Published In

Volume / Issue

  • 72 / 12

Start / End Page

  • 1689 - 1696

PubMed ID

  • 28180239

Electronic International Standard Serial Number (EISSN)

  • 1758-535X

Digital Object Identifier (DOI)

  • 10.1093/gerona/glx001


  • eng

Conference Location

  • United States