The relation between postoperative cognitive disorders and brain damage biomarkers after major urologic surgery: a prospective cohort study

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Şentürk E., Sungur Z., Şentürk Çiftçi H., Kıkılı M. İ., Şanlı M. Ö., Kıvanç D., ...Daha Fazla

Perioperative Medicine, cilt.14, sa.116, ss.1-13, 2025 (Hakemli Dergi)

Özet

Abstract

Background Postoperative neurocognitive disorders (PNDs) are highly prevalent among the elderly population.

Identifying an ideal biomarker for postoperative delirium (POD) and postoperative cognitive dysfunction (POCD)

remains a significant challenge. This study aimed to investigate the relationship between these syndromes and various

biomarkers, including S-100β, neuron-specific enolase (NSE), interleukin-6 (IL-6), and high-mobility group box-1

(HMGB-1).

Methods The study included patients aged 60 years and older who underwent surgery for primary urologic

malignancies. POD was evaluated in the recovery room using the Confusion Assessment Method (CAM). POCD

was assessed preoperatively and at the first week (POCD1) and third month (POCD3) postoperatively using Addenbrooke’s

Cognitive Examination-III (ACE-III). Biomarker levels of S-100β, neuron-specific enolase (NSE), interleukin-6

(IL-6), and high-mobility group box-1 (HMGB-1) were measured using enzyme-linked immunosorbent assay (ELISA).

Results A total of 54 patients completed the study. POD was diagnosed in 12 patients (22.2%), while POCD1

and POCD3 were identified in 17 (31.5%) patients and 12 (22.2%) patients respectively. The mean age of the participants

was 73.8 Å} 7.1 years. Preoperative levels of NSE were significantly higher in patients with POD compared

to those without (p = 0.04). Additionally, preoperative and postoperative IL-6 levels, as well as preoperative and postoperative

S-100β levels, were significantly elevated in patients with POCD1 compared to those without (p < 0.01,

p = 0.01, p < 0.01, and p = 0.03, respectively). Furthermore, preoperative IL-6 and S-100β levels were higher in patients

with POCD3 compared to those without (p = 0.01 and p = 0.03, respectively).

Conclusions In major urologic oncologic surgeries among geriatric patients, IL-6 and S-100β were found to be associated

with both POD and POCD, while NSE was specifically associated with POD.

Keywords Postoperative cognitive dysfunction (POCD), Postoperative delirium (POD), S-100β, Neuron-specific

enolase (NSE), Interleukin-6 (IL-6), High-mobility group box 1 (HMGB-1)