Post-operative delirium associated with metabolic alterations following hemi-arthroplasty in older patients

Yong Guo, Yingchuan Li, Yinan Zhang, Shudong Fang, Xiaotao Xu, Aihua Zhao, Junfeng Zhang, Jia V. Li, Daqing Ma, Wei JIA*, Wei Jiang

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)

Abstract

Background: post-operative delirium (POD) is a common complication in older patients, though a possible link between metabolic changes and POD development has yet to be investigated. Methods: older patients with hip fracture who underwent hemi-arthroplasty were recruited, and delirious states were assessed for 3 days after surgery using the confusion assessment method-Chinese revision. Simultaneously, fasting blood samples were collected on the morning of surgery and on the first post-operative day. Ultimately, 244 older patients who met the inclusion and exclusion criteria were assessed. Blood samples from 60 patients with POD and 60 matched controls were analysed using metabolomics platforms. Results: sixty patients (24.6%) developed POD. Principal component analysis scores plot and cross-validated scores plots from orthogonal partial least squares-discriminant analysis were implemented to visualise the differences in metabolites between the two groups before and after surgery (P < 0.05). Our data indicate that levels of ω3 and ω6 fatty acids were lower in the POD group than in the NPOD (non-POD) group both before and after surgery; tricarboxylic cycle intermediate levels were lower in the POD group than in the NPOD group, but glycolysis products were higher in the POD group than in the NPOD group after surgery. Furthermore, the branched-chain amino acid (BCAA)/aromatic amino acid ratio was lower in the POD group than in the NPOD group after surgery. Conclusions: metabolic abnormalities, including deficiencies in ω3 and ω6 fatty acids, perturbations in tricarboxylic cycle and oxidative stress and metabolic imbalances in BCAA and AAA might contribute to POD development.

Original languageEnglish
Pages (from-to)88-95
Number of pages8
JournalAge and Ageing
Volume49
Issue number1
DOIs
Publication statusPublished - 1 Dec 2019

Scopus Subject Areas

  • Ageing
  • Geriatrics and Gerontology

User-Defined Keywords

  • hip fracture
  • metabolomics
  • older patients
  • post-operative delirium

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