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- Title
Insulin resistance and osteocalcin associate with the incidence and severity of postoperative delirium in elderly patients undergoing joint replacement.
- Authors
Yang Mi; Ouyang Wen; Zhou Lei; Long Ge; Liu Xing; He Xi
- Abstract
Aim: While insulin sensitivity plays an important role in maintaining glucose metabolic homeostasis and cognitive function, its impact on postoperative delirium (POD) remains unclear. This study aimed to investigate the association between POD and indicators of insulin sensitivity, including insulin resistance and osteocalcin. Methods: A total of 120 elderly patients undergoing joint replacement were recruited and divided into delirium and non-delirium groups. Plasma and cerebrospinal fluid (CSF) samples were collected for the analysis of biomarkers, including insulin, uncarboxylated osteocalcin (ucOC), total osteocalcin (tOC), and glucose. Insulin resistance was assessed through the homeostatic model assessment of insulin resistance (HOMA-IR). Main results: Out of the total, 28 patients (23.3%) experienced POD within 5 days after surgery. Patients with delirium exhibited higher levels of preoperative HOMA-IR and ucOC in CSF and plasma, and of tOC in CSF (P = 0.028, P < 0.001, P = 0.005, P = 0.019). After adjusting for variables, including age, Mini-Mental State Examination score, surgical site and preoperative fracture, only preoperative ucOC in CSF and HOMA-IR were significantly linked to the incidence of delirium (OR = 5.940, P = 0.008; OR = 1.208, P = 0.046, respectively), both of which also correlated with the severity of delirium (P = 0.007, P < 0.001). Receiver operating curve analysis indicated that preoperative HOMA-IR and ucOC in CSF might partly predict POD (area under the curve [AUC] = 0.697, 95% confidence interval [CI] = 0.501-0.775, AUC = 0.745, 95% CI = 0.659-0.860). Conclusions: We observed that preoperative elevated HOMA-IR and ucOC in CSF were associated with the incidence and severity of POD. While these preliminary results need confirmation, they suggest a potential involvement of insulin resistance and osteocalcin in the pathological mechanism of POD.
- Subjects
CEREBROSPINAL fluid examination; BLOOD sugar analysis; OSTEOCALCIN; INSULIN sensitivity; RECEIVER operating characteristic curves; RESEARCH funding; BLOOD collection; QUESTIONNAIRES; SEVERITY of illness index; INSULIN; DESCRIPTIVE statistics; PREOPERATIVE care; AGE distribution; INSULIN resistance; BONE fractures; ODDS ratio; DELIRIUM; ARTIFICIAL joints; CONFIDENCE intervals; SURGICAL site; DISEASE complications; OLD age
- Publication
Geriatrics & Gerontology International, 2024, Vol 24, Issue 4, p421
- ISSN
1444-1586
- Publication type
Article
- DOI
10.1111/ggi.14848