Association of perioperative plasma concentration of neurofilament light with delirium after cardiac surgery: a nested observational study

Charles H Brown; Alexander S Kim; Lisa Yanek; Alexandria Lewis; Kaushik Mandal; Lan Le; Jing Tian; Karin J Neufeld; Charles Hogue; Abhay Moghekar

doi:10.1016/j.bja.2023.10.043

Association of perioperative plasma concentration of neurofilament light with delirium after cardiac surgery: a nested observational study

Br J Anaesth. 2024 Feb;132(2):312-319. doi: 10.1016/j.bja.2023.10.043. Epub 2023 Dec 19.

Authors

Charles H Brown¹, Alexander S Kim², Lisa Yanek³, Alexandria Lewis⁴, Kaushik Mandal⁵, Lan Le⁶, Jing Tian⁷, Karin J Neufeld⁸, Charles Hogue⁹, Abhay Moghekar⁴

Affiliations

¹ Department of Anesthesiology & Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: cbrownv@jhmi.edu.
² Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Medicine, Highland Hospital-Alameda Health System, Oakland, CA, USA.
³ Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁴ Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁵ Department of Surgery, Detroit Medical Center, Detroit, MI, USA.
⁶ Department of Anesthesiology & Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; George Washington University School of Medicine and Health Sciences, Washington DC, USA.
⁷ Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA; Emergent Biosolutions Company, Gaithersburg, MD, USA.
⁸ Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Psychiatry and Behavioural Neurosciences, Faculty of Health Sciences, McMaster University, ON, Canada.
⁹ Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.

PMID: 38114355
PMCID: PMC10808824 (available on 2025-02-01)
DOI: 10.1016/j.bja.2023.10.043

Abstract

Background: Neurofilament light is a blood-based biomarker of neuroaxonal injury that can provide insight into perioperative brain vulnerability and injury. Prior studies have suggested that increased baseline and postoperative concentrations of neurofilament light are associated with delirium after noncardiac surgery, but results are inconsistent. Results have not been reported in cardiac surgery patients, who are among those at highest risk for delirium. We hypothesised that perioperative blood concentrations of neurofilament light (both baseline and change from baseline to postoperative day 1) are associated with delirium after cardiac surgery.

Methods: This study was nested in a trial of arterial blood pressure targeting during cardiopulmonary bypass using cerebral autoregulation metrics. Blood concentrations of neurofilament light were measured at baseline and on postoperative day 1. The primary outcome was postoperative delirium. Regression models were used to examine the associations between neurofilament light concentration and delirium and delirium severity, adjusting for age, sex, race, logistic European System for Cardiac Operative Risk Evaluation, bypass duration, and cognition.

Results: Delirium occurred in 44.6% of 175 patients. Baseline neurofilament light concentration was higher in delirious than in non-delirious patients (median 20.7 pg ml^-1 [IQR 16.1-33.2] vs median 15.5 pg ml^-1 [IQR 12.1-24.2], P<0.001). In adjusted models, greater baseline neurofilament light concentration was associated with delirium (odds ratio, 1.027; 95% confidence interval, 1.003-1.053; P=0.029) and delirium severity. From baseline to postoperative day 1, neurofilament light concentration increased by 42%, but there was no association with delirium.

Conclusions: Baseline neurofilament light concentration, but not change from baseline to postoperative day 1, was associated with delirium after cardiac surgery.

Keywords: blood biomarker; cardiac surgery; geriatrics; neurofilament light; postoperative delirium.

Publication types

Observational Study

MeSH terms

Brain
Cardiac Surgical Procedures* / adverse effects
Delirium* / diagnosis
Delirium* / etiology
Humans
Intermediate Filaments
Postoperative Complications / diagnosis
Prospective Studies

Abstract

Publication types

MeSH terms

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