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<p>Perioperative neurocognitive disorder (PND) is a common complication following thoracic surgery and often leading to poor outcomes. Despite ongoing research, effective treatments for late PND remain limited. Identifying reliable biomarkers for early diagnosis is, therefore, essential. A prospective cohort study was conducted with 60 elderly patients undergoing thoracic surgery. Serum samples were collected within 10&#xa0;minutes prior to anesthesia and following extubation to measure adiponectin (APN), cyclic adenosine monophosphate (cAMP), protein kinase A (PKA), aquaporin-4 (AQP4) and brain-derived neurotrophic factor (BDNF). Among PND patients, serum APN, PKA, AQP4, and BDNF levels were markedly decreased compared with the normal group. While serum cAMP (HR = 1.087, <i>p</i> = 0.695, 95% CI [0.284–4.166]) and PKA (HR = 0.996, <i>p</i> = 0.09, 95% CI [0.491–0.947]) were not significantly correlated with PND, serum APN (HR = 0.307, 95% CI [0.113–0.835], <i>p</i> = 0.021), AQP4 (HR = 0.204, 95% CI [0.060–0.697], <i>p</i> = 0.011), and BDNF (HR = 0.382, 95% CI [0.177–0.823], <i>p</i> = 0.014) were protective factors against PND. ROC analysis demonstrated that APN (AUC = 0.68, 95% CI [0.51–0.87]), AQP4 (AUC = 0.73, 95% CI [0.59–0.87]), BDNF (AUC = 0.73, 95% CI [0.59–0.87]), and the model of combining those biomarkers (AUC = 0.91, 95% CI [0.83–0.99]) could predict PND. PND patients exhibited a lower protective stress response to surgical trauma. High serum APN, AQP4, and BDNF levels were independent protective factors for PND, and a combined model of these biomarkers showed predictive potential for PND.</p>

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Risk Assessment of Serum Biomarkers with Perioperative Neurocognitive Dysfunction in Elderly Patients Undergoing Thoracic Surgery: A Prospective Cohort Study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月29日

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  • Zhijing Zhang,
  • Di Wang,
  • Riguang Zhong,
  • Yuqing Chi,
  • Xiawei Lai,
  • Xiaoqun Su,
  • Shuxian Liu,
  • Huiqun Chen,
  • Haihui Xie

摘要

Perioperative neurocognitive disorder (PND) is a common complication following thoracic surgery and often leading to poor outcomes. Despite ongoing research, effective treatments for late PND remain limited. Identifying reliable biomarkers for early diagnosis is, therefore, essential. A prospective cohort study was conducted with 60 elderly patients undergoing thoracic surgery. Serum samples were collected within 10 minutes prior to anesthesia and following extubation to measure adiponectin (APN), cyclic adenosine monophosphate (cAMP), protein kinase A (PKA), aquaporin-4 (AQP4) and brain-derived neurotrophic factor (BDNF). Among PND patients, serum APN, PKA, AQP4, and BDNF levels were markedly decreased compared with the normal group. While serum cAMP (HR = 1.087, p = 0.695, 95% CI [0.284–4.166]) and PKA (HR = 0.996, p = 0.09, 95% CI [0.491–0.947]) were not significantly correlated with PND, serum APN (HR = 0.307, 95% CI [0.113–0.835], p = 0.021), AQP4 (HR = 0.204, 95% CI [0.060–0.697], p = 0.011), and BDNF (HR = 0.382, 95% CI [0.177–0.823], p = 0.014) were protective factors against PND. ROC analysis demonstrated that APN (AUC = 0.68, 95% CI [0.51–0.87]), AQP4 (AUC = 0.73, 95% CI [0.59–0.87]), BDNF (AUC = 0.73, 95% CI [0.59–0.87]), and the model of combining those biomarkers (AUC = 0.91, 95% CI [0.83–0.99]) could predict PND. PND patients exhibited a lower protective stress response to surgical trauma. High serum APN, AQP4, and BDNF levels were independent protective factors for PND, and a combined model of these biomarkers showed predictive potential for PND.