Serum Biomarkers in Postoperative Delirium after Esophagectomy.

Abstract Background Esophagectomy is associated with postoperative delirium but its pathophysiology is not well defined. We conducted this study to measure the relationship among serum biomarkers of inflammation and neuronal injury and delirium incidence and severity in a cohort of esophagectomy patients. Methods Blood samples were obtained from patients at preoperative and postoperative days 1 and 3, and analyzed for S100 calcium-binding protein B, C-Reactive Protein, interleukins 8, 10, tumor necrosis factor-alpha, insulin like growth factor 1. Delirium was assessed using Richmond Agitation Sedation Scale and Confusion Assessment Method for Intensive Care Unit twice daily. Delirium severity was assessed using Delirium Rating Scale Revised-98 once daily. Results Samples from 71 patients were included. Preoperative biomarker concentrations were not associated with postoperative delirium. Significant differences in change in concentrations from preoperative to postoperative day 1 were seen in interleukin-8 (delirium: 38.6 interquartile range (IQR): 29.3, 69.8; no delirium: 24.8 IQR: 16.0, 41.7, p=0.022), and interleukin-10 (delirium: 26.1 IQR: 13.9, 36.7; no delirium: 12.4 IQR: 7.7, 25.7, p=0.025). Greater postoperative increase in S100 calcium-binding protein B (Spearman r=0.289, p=0.020) and lower levels of Insulin-like Growth Factor 1 were correlated with greater delirium severity (Spearman r=-0.27, p=0.040). Greater CRP change quartiles were associated with higher delirium incidence adjusting for severity of illness (OR=1.68, 95% CI: 1.03,2.75, p=0.037) or comorbidities (OR=1.70, 95% CI: 1.05,2.76, p=0.030). Conclusions Differences in change in serum CRP, IL-8 and IL-10 concentrations were associated with postoperative delirium suggesting biomarker measurement early in the postoperative course is associated with delirium.