A case series on the value of tau and neurofilament protein levels to predict and detect delirium in cardiac surgery patients

Thomas Saller, Axel Petzold, Henrik Zetterberg, Jens Kuhle, Daniel Chappell, Vera von Dossow, Felix Klawitter, Tobias Schurholz, Christian Hagl, Daniel A. Reuter, Bernhard Zwissler, Johannes Ehler

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

BACKGROUND: Delirium following cardiac surgery is a relevant complication in the majority of elderly patients but its prediction is challenging. Cardiopulmonary bypass, essential for many interventions in cardiac surgery, is responsible for a severe inflammatory response leading to neuroinflammation and subsequent delirium. Neurofilament light protein (NfL) and tau protein (tau) are specific biomarkers to detect neuroaxonal injury as well as glial fibrillary acidic protein (GFAP), a marker of astrocytic activation. METHODS: We thought to examine the perioperative course of these markers in a case series of each three cardiac surgery patients under off-pump cardiac arterial bypass without evolving delirium (OPCAB-NDEL), patients with a procedure under cardio-pulmonary bypass (CPB) without delirium (CPB-NDEL) and delirium after a CPB procedure (CPB-DEL). Delirium was diagnosed by the Confusion Assessment Method for the ICU and chart reviews. RESULTS: We observed increased preoperative levels of tau in patients with later delirium, whereas values of NfL and GFAP did not differ. In the postoperative course, all biomarkers increased multi-fold. NfL levels sharply increased in patients with CPB reaching the highest levels in the CPB-DEL group. CONCLUSION: Tau and NfL might be of benefit to identify patients in cardiac surgery at risk for delirium and to detect patients with the postoperative emergence of delirium.
Original languageEnglish
Pages (from-to)241-246
JournalBiomedical papers of the Medical Faculty of the University Palacky, Olomouc, Czechoslovakia
Volume163
Issue number3
DOIs
Publication statusPublished - 2019

Cite this

Saller, Thomas ; Petzold, Axel ; Zetterberg, Henrik ; Kuhle, Jens ; Chappell, Daniel ; von Dossow, Vera ; Klawitter, Felix ; Schurholz, Tobias ; Hagl, Christian ; Reuter, Daniel A. ; Zwissler, Bernhard ; Ehler, Johannes. / A case series on the value of tau and neurofilament protein levels to predict and detect delirium in cardiac surgery patients. In: Biomedical papers of the Medical Faculty of the University Palacky, Olomouc, Czechoslovakia. 2019 ; Vol. 163, No. 3. pp. 241-246.
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title = "A case series on the value of tau and neurofilament protein levels to predict and detect delirium in cardiac surgery patients",
abstract = "BACKGROUND: Delirium following cardiac surgery is a relevant complication in the majority of elderly patients but its prediction is challenging. Cardiopulmonary bypass, essential for many interventions in cardiac surgery, is responsible for a severe inflammatory response leading to neuroinflammation and subsequent delirium. Neurofilament light protein (NfL) and tau protein (tau) are specific biomarkers to detect neuroaxonal injury as well as glial fibrillary acidic protein (GFAP), a marker of astrocytic activation. METHODS: We thought to examine the perioperative course of these markers in a case series of each three cardiac surgery patients under off-pump cardiac arterial bypass without evolving delirium (OPCAB-NDEL), patients with a procedure under cardio-pulmonary bypass (CPB) without delirium (CPB-NDEL) and delirium after a CPB procedure (CPB-DEL). Delirium was diagnosed by the Confusion Assessment Method for the ICU and chart reviews. RESULTS: We observed increased preoperative levels of tau in patients with later delirium, whereas values of NfL and GFAP did not differ. In the postoperative course, all biomarkers increased multi-fold. NfL levels sharply increased in patients with CPB reaching the highest levels in the CPB-DEL group. CONCLUSION: Tau and NfL might be of benefit to identify patients in cardiac surgery at risk for delirium and to detect patients with the postoperative emergence of delirium.",
author = "Thomas Saller and Axel Petzold and Henrik Zetterberg and Jens Kuhle and Daniel Chappell and {von Dossow}, Vera and Felix Klawitter and Tobias Schurholz and Christian Hagl and Reuter, {Daniel A.} and Bernhard Zwissler and Johannes Ehler",
year = "2019",
doi = "10.5507/bp.2019.043",
language = "English",
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pages = "241--246",
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Saller, T, Petzold, A, Zetterberg, H, Kuhle, J, Chappell, D, von Dossow, V, Klawitter, F, Schurholz, T, Hagl, C, Reuter, DA, Zwissler, B & Ehler, J 2019, 'A case series on the value of tau and neurofilament protein levels to predict and detect delirium in cardiac surgery patients' Biomedical papers of the Medical Faculty of the University Palacky, Olomouc, Czechoslovakia, vol. 163, no. 3, pp. 241-246. https://doi.org/10.5507/bp.2019.043

A case series on the value of tau and neurofilament protein levels to predict and detect delirium in cardiac surgery patients. / Saller, Thomas; Petzold, Axel; Zetterberg, Henrik; Kuhle, Jens; Chappell, Daniel; von Dossow, Vera; Klawitter, Felix; Schurholz, Tobias; Hagl, Christian; Reuter, Daniel A.; Zwissler, Bernhard; Ehler, Johannes.

In: Biomedical papers of the Medical Faculty of the University Palacky, Olomouc, Czechoslovakia, Vol. 163, No. 3, 2019, p. 241-246.

Research output: Contribution to journalArticleAcademicpeer-review

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T1 - A case series on the value of tau and neurofilament protein levels to predict and detect delirium in cardiac surgery patients

AU - Saller, Thomas

AU - Petzold, Axel

AU - Zetterberg, Henrik

AU - Kuhle, Jens

AU - Chappell, Daniel

AU - von Dossow, Vera

AU - Klawitter, Felix

AU - Schurholz, Tobias

AU - Hagl, Christian

AU - Reuter, Daniel A.

AU - Zwissler, Bernhard

AU - Ehler, Johannes

PY - 2019

Y1 - 2019

N2 - BACKGROUND: Delirium following cardiac surgery is a relevant complication in the majority of elderly patients but its prediction is challenging. Cardiopulmonary bypass, essential for many interventions in cardiac surgery, is responsible for a severe inflammatory response leading to neuroinflammation and subsequent delirium. Neurofilament light protein (NfL) and tau protein (tau) are specific biomarkers to detect neuroaxonal injury as well as glial fibrillary acidic protein (GFAP), a marker of astrocytic activation. METHODS: We thought to examine the perioperative course of these markers in a case series of each three cardiac surgery patients under off-pump cardiac arterial bypass without evolving delirium (OPCAB-NDEL), patients with a procedure under cardio-pulmonary bypass (CPB) without delirium (CPB-NDEL) and delirium after a CPB procedure (CPB-DEL). Delirium was diagnosed by the Confusion Assessment Method for the ICU and chart reviews. RESULTS: We observed increased preoperative levels of tau in patients with later delirium, whereas values of NfL and GFAP did not differ. In the postoperative course, all biomarkers increased multi-fold. NfL levels sharply increased in patients with CPB reaching the highest levels in the CPB-DEL group. CONCLUSION: Tau and NfL might be of benefit to identify patients in cardiac surgery at risk for delirium and to detect patients with the postoperative emergence of delirium.

AB - BACKGROUND: Delirium following cardiac surgery is a relevant complication in the majority of elderly patients but its prediction is challenging. Cardiopulmonary bypass, essential for many interventions in cardiac surgery, is responsible for a severe inflammatory response leading to neuroinflammation and subsequent delirium. Neurofilament light protein (NfL) and tau protein (tau) are specific biomarkers to detect neuroaxonal injury as well as glial fibrillary acidic protein (GFAP), a marker of astrocytic activation. METHODS: We thought to examine the perioperative course of these markers in a case series of each three cardiac surgery patients under off-pump cardiac arterial bypass without evolving delirium (OPCAB-NDEL), patients with a procedure under cardio-pulmonary bypass (CPB) without delirium (CPB-NDEL) and delirium after a CPB procedure (CPB-DEL). Delirium was diagnosed by the Confusion Assessment Method for the ICU and chart reviews. RESULTS: We observed increased preoperative levels of tau in patients with later delirium, whereas values of NfL and GFAP did not differ. In the postoperative course, all biomarkers increased multi-fold. NfL levels sharply increased in patients with CPB reaching the highest levels in the CPB-DEL group. CONCLUSION: Tau and NfL might be of benefit to identify patients in cardiac surgery at risk for delirium and to detect patients with the postoperative emergence of delirium.

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