The link between the early surgery-induced inflammatory response and postoperative cognitive dysfunction in older patients.
cancer
cognitive decline
inflammation
postoperative neurocognitive disorder
Journal
Journal of the American Geriatrics Society
ISSN: 1532-5415
Titre abrégé: J Am Geriatr Soc
Pays: United States
ID NLM: 7503062
Informations de publication
Date de publication:
22 Mar 2024
22 Mar 2024
Historique:
revised:
14
01
2024
received:
03
05
2023
accepted:
25
02
2024
medline:
22
3
2024
pubmed:
22
3
2024
entrez:
22
3
2024
Statut:
aheadofprint
Résumé
Postoperative cognitive dysfunction (POCD) is a common complication in older patients with cancer and is associated with decreased quality of life and increased disability and mortality rates. Systemic inflammation resulting in neuroinflammation is considered important in the pathogenesis of POCD. The aim of this study was to explore the association between the early surgery-induced inflammatory response and POCD within 3 months after surgery in older cancer patients. Patients ≥65 years in need of surgery for a solid tumor were included in a prospective cohort study. Plasma levels of C-reactive protein (CRP), interleukin-1 beta (IL-1β), IL-6, IL-10, and Neutrophil gelatinase-associated lipocalin (NGAL) were measured perioperatively. Cognitive performance was assessed preoperatively and 3 months after surgery. POCD was defined as a decline in cognitive test scores of ≥25% on ≥2 of five tests within the different cognitive domains of memory, executive functioning, and information processing speed. Logistic regression analysis was performed. POCD was observed in 44 (17.7%) of 248 included patients. Age >75, preoperative Mini-Mental State Examination (MMSE) score ≤26 and major surgery were independent significant predictors for POCD. In multivariate logistic regression analysis, no significant associations were shown between the early surgery-induced inflammatory response and either POCD or decline within the different cognitive domains. This study shows that one out of six older patients with cancer developed POCD within 3 months after surgery. The early surgery-induced inflammatory response was neither associated with POCD, nor with decline in the separate cognitive domains. Further research is necessary for better understanding of the complex etiology of POCD.
Sections du résumé
BACKGROUND
BACKGROUND
Postoperative cognitive dysfunction (POCD) is a common complication in older patients with cancer and is associated with decreased quality of life and increased disability and mortality rates. Systemic inflammation resulting in neuroinflammation is considered important in the pathogenesis of POCD. The aim of this study was to explore the association between the early surgery-induced inflammatory response and POCD within 3 months after surgery in older cancer patients.
METHODS
METHODS
Patients ≥65 years in need of surgery for a solid tumor were included in a prospective cohort study. Plasma levels of C-reactive protein (CRP), interleukin-1 beta (IL-1β), IL-6, IL-10, and Neutrophil gelatinase-associated lipocalin (NGAL) were measured perioperatively. Cognitive performance was assessed preoperatively and 3 months after surgery. POCD was defined as a decline in cognitive test scores of ≥25% on ≥2 of five tests within the different cognitive domains of memory, executive functioning, and information processing speed. Logistic regression analysis was performed.
RESULTS
RESULTS
POCD was observed in 44 (17.7%) of 248 included patients. Age >75, preoperative Mini-Mental State Examination (MMSE) score ≤26 and major surgery were independent significant predictors for POCD. In multivariate logistic regression analysis, no significant associations were shown between the early surgery-induced inflammatory response and either POCD or decline within the different cognitive domains.
CONCLUSIONS
CONCLUSIONS
This study shows that one out of six older patients with cancer developed POCD within 3 months after surgery. The early surgery-induced inflammatory response was neither associated with POCD, nor with decline in the separate cognitive domains. Further research is necessary for better understanding of the complex etiology of POCD.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024 The Authors. Journal of the American Geriatrics Society published by Wiley Periodicals LLC on behalf of The American Geriatrics Society.
Références
Verduzco‐Aguirre HC, Gomez‐Moreno C, Chavarri‐Guerra Y, Soto‐Perez‐de‐Celis E. Predicting life expectancy for older adults with cancer in clinical practice: implications for shared decision‐making. Curr Oncol Rep. 2019;21(8):68.
Deo SVS, Sharma J, Kumar S. GLOBOCAN 2020 report on global cancer burden: challenges and opportunities for surgical oncologists. Ann Surg Oncol. 2022;29(11):6497‐6500.
Plas M, Rotteveel E, Izaks GJ, et al. Cognitive decline after major oncological surgery in the elderly. Eur J Cancer. 2017;86:394‐402.
Moller JT, Cluitmans P, Rasmussen LS, et al. Long‐term postoperative cognitive dysfunction in the elderly: ISPOCD1 study. Lancet. 1998;351(9106):857‐861.
Shoair O, Grasso M II, Lahaye L, Daniel R, Biddle C, Slattum P. Incidence and risk factors for postoperative cognitive dysfunction in older adults undergoing major noncardiac surgery: a prospective study. J Anaesthesiol Clin Pharmacol. 2015;31(1):30‐36.
Steinmetz J, Christensen KB, Lund T, Lohse N, Rasmussen LS, Group the I. Long‐term consequences of postoperative cognitive dysfunction. Anesthesiology. 2009;110(3):548‐555.
Evered L, Silbert B, Knopman DS, et al. Recommendations for the nomenclature of cognitive change associated with anaesthesia and surgery—2018. Br J Anaesth. 2018;121(5):1005‐1012.
Tasbihgou SR, Absalom AR. Postoperative neurocognitive disorders. Korean J Anesthesiol. 2021;74(1):15‐22.
Monk TG, Price CC. Postoperative cognitive disorders. Curr Opin Crit Care. 2011;17(4):376‐381.
de Martinis M, Franceschi C, Monti D, Ginaldi L. Inflamm‐ageing and lifelong antigenic load as major determinants of ageing rate and longevity. FEBS Lett. 2005;579(10):2035‐2039.
Ni Choileain N, Redmond HP. Cell response to surgery. Arch Surg. 2006;141(11):1132‐1140.
Ransohoff RM. How neuroinflammation contributes to neurodegeneration. Science (80‐). 2016;353(6301):777‐783.
Brattinga B, Plas M, Spikman JM, et al. The association between the inflammatory response following surgery and post‐operative delirium in older oncological patients: a prospective cohort study. Age Ageing. 2022;51(2):afab237.
Weerink LBM, van Leeuwen BL, Gernaat SAM, et al. Vitamin status and the development of postoperative cognitive decline in elderly surgical oncologic patients. Ann Surg Oncol. 2018;25(1):231‐238.
Du J, Plas M, Absalom AR, van Leeuwen BL, de Bock GH. The association of preoperative anxiety and depression with neurocognitive disorder following oncological surgery. J Surg Oncol. 2020;121(4):676‐687.
Plas M, de Haan JJ, van der Wal‐Huisman H, et al. The systemic impact of a surgical procedure in older oncological patients. Eur J Surg Oncol. 2019;45(8):1403‐1409.
Plas M, Rutgers A, van der Wal‐Huisman H, et al. The association between the inflammatory response to surgery and postoperative complications in older patients with cancer; a prospective prognostic factor study. J Geriatr Oncol. 2020;11(5):873‐879.
Bras L, Driessen DAJJ, de Vries J, et al. Patients with head and neck cancer: are they frailer than patients with other solid malignancies? Eur J Cancer Care (Engl). 2020;29(1):e13170.
Meulendijks FG, Hamaker ME, Boereboom FTJ, Kalf A, Vögtlander NPJ, van Munster BC. Groningen frailty indicator in older patients with end‐stage renal disease. Ren Fail. 2015;37(9):1419‐1424.
Folstein MF, Folstein SE, McHugh PR. “Mini‐mental state”: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189‐198.
Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien‐Dindo classification of surgical complications: five‐year experience. Ann Surg. 2009;250(2):187‐196.
Scheffer AC, van Munster BC, Schuurmans MJ, de Rooij SE. Assessing severity of delirium by the delirium observation screening scale. Int J Geriatr Psychiatry. 2011;26(3):284‐291.
van der Elst WIM, van Boxtel MPJ, van Breukelen GJP, Jolles J. Rey's verbal learning test: normative data for 1855 healthy participants aged 24–81 years and the influence of age, sex, education, and mode of presentation. J Int Neuropsychol Soc. 2005;11(3):290‐302.
Reitan RM, Wolfson D. The use of serial testing in evaluating the need for comprehensive neuropsychological testing of adults. Appl Neuropsychol. 2008;15(1):21‐32.
Ruff RM, Light RH, Evans RW. The ruff figural fluency test: a normative study with adults. Dev Neuropsychol. 1987;3(1):37‐51.
Stump DA, Newman SP, Coker LH, Phipps JH, Miller CC. A113 persistence of neuropsychological deficits following CABG. Anesthesiology. 1990;73(3A):113.
Lin E, Calvano SE, Lowry SF. Inflammatory cytokines and cell response in surgery. Surgery. 2000;127(2):117‐126.
Zhang J‐M, An J. Cytokines, inflammation, and pain. Int Anesthesiol Clin. 2007;45(2):27‐37.
Chakraborty S, Kaur S, Guha S, Batra SK. The multifaceted roles of neutrophil gelatinase associated lipocalin (NGAL) in inflammation and cancer. Biochim Biophys Acta Rev Cancer. 2012;1826(1):129‐169.
Mocellin S, Marincola F, Riccardo Rossi C, Nitti D, Lise M. The multifaceted relationship between IL‐10 and adaptive immunity: putting together the pieces of a puzzle. Cytokine Growth Factor Rev. 2004;15(1):61‐76.
Sapan HB, Paturusi I, Jusuf I, et al. Pattern of cytokine (IL‐6 and IL‐10) level as inflammation and anti‐inflammation mediator of multiple organ dysfunction syndrome (MODS) in polytrauma. Int J Burns Trauma. 2016;6(2):37‐43.
Huang H, Lin F, Cen L, Jing R, Pan L. Cancer‐related anemia is a risk factor for medium‐term postoperative cognitive dysfunction in laparoscopic surgery patients: an observational prospective study. Berardi N, ed. Neural Plast. 2020;2020:4847520.
Culley DJ, Flaherty D, Fahey MC, et al. Poor performance on a preoperative cognitive screening test predicts postoperative complications in older orthopedic surgical patients. Anesthesiology. 2017;127(5):765‐774.
Monk TG, Weldon BC, Garvan CW, et al. Predictors of cognitive dysfunction after major noncardiac surgery. Anesthesiology. 2008;108(1):18‐30.
Yuhe K, Huey Chew ST, Ang AS, et al. Comparison of postoperative cognitive decline in patients undergoing conventional vs miniaturized cardiopulmonary bypass: a randomized, controlled trial. Ann Card Anaesth. 2020;23(3):309‐314.
Ren S, Yuan F, Yuan S, Zang C, Zhang Y, Lang B. Early cognitive dysfunction in elderly patients after total knee arthroplasty: an analysis of risk factors and cognitive functional levels. Ni C, ed. Biomed Res Int. 2022;2022:5372603.
Nemeth E, Vig K, Racz K, et al. Influence of the postoperative inflammatory response on cognitive decline in elderly patients undergoing on‐pump cardiac surgery: a controlled, prospective observational study. BMC Anesthesiol. 2017;17(1):113.
Li Y‐C, Xi C‐H, An Y‐F, Dong W‐H, Zhou M. Perioperative inflammatory response and protein S‐100β concentrations – relationship with post‐operative cognitive dysfunction in elderly patients. Acta Anaesthesiol Scand. 2012;56(5):595‐600.
Hudetz JA, Gandhi SD, Iqbal Z, Patterson KM, Pagel PS. Elevated postoperative inflammatory biomarkers are associated with short‐ and medium‐term cognitive dysfunction after coronary artery surgery. J Anesth. 2011;25(1):1‐9.
Kristek G, Radoš I, Kristek D, et al. Influence of postoperative analgesia on systemic inflammatory response and postoperative cognitive dysfunction after femoral fractures surgery: a randomized controlled trial. Reg Anesth Pain Med. 2019;44(1):59‐68.
Danielson M, Wiklund A, Granath F, et al. Neuroinflammatory markers associate with cognitive decline after major surgery: findings of an explorative study. Ann Neurol. 2020;87(3):370‐382.
DiSabato DJ, Quan N, Godbout JP. Neuroinflammation: the devil is in the details. J Neurochem. 2016;139(S2):136‐153.
Watt J, Tricco AC, Talbot‐Hamon C, et al. Identifying older adults at risk of harm following elective surgery: a systematic review and meta‐analysis. BMC Med. 2018;16(1):2.
McSorley ST, Watt DG, Horgan PG, McMillan DC. Postoperative systemic inflammatory response, complication severity, and survival following surgery for colorectal cancer. Ann Surg Oncol. 2016;23(9):2832‐2840.
Festen S, Kok M, Hopstaken JS, et al. How to incorporate geriatric assessment in clinical decision‐making for older patients with cancer. An implementation study. J Geriatr Oncol. 2019;10(6):951‐959.
Rasmussen LS, Larsen K, Houx P, et al. The assessment of postoperative cognitive function. Acta Anaesthesiol Scand. 2001;45(3):275‐289.
Dutra FF, Alves LS, Rodrigues D, et al. Hemolysis‐induced lethality involves inflammasome activation by heme. Proc Natl Acad Sci. 2014;111(39):E4110‐E4118.
Evered LA, Silbert BS. Postoperative cognitive dysfunction and noncardiac surgery. Anesth Analg. 2018;127(2):496‐505.
Borchers F, Spies CD, Feinkohl I, et al. Methodology of measuring postoperative cognitive dysfunction: a systematic review. Br J Anaesth. 2021;126(6):1119‐1127.
Stern M, Nieuwenhuijs‐Moeke GJ, Absalom A, et al. Association between anaesthesia‐related factors and postoperative neurocognitive disorder: a post‐hoc analysis. BMC Anesthesiol. 2023;23(1):368.