The Effect of Preoperative Methylprednisolone on Postoperative Delirium in Older Patients Undergoing Gastrointestinal Surgery: A Randomized, Double-Blind, Placebo-Controlled Trial

doi:10.1093/gerona/glab248

	The Effect of Preoperative Methylprednisolone on Postoperative Delirium in Older Patients Undergoing Gastrointestinal Surgery: A Randomized, Double-Blind, Placebo-Controlled Trial
	Xiang, Xiao-bing 1,4; Chen, Hao 2,3; Wu, Ying-li 1,4; Wang, Ke 1,4; Yue, Xiang 1,4; Cheng, Xin-qi 2,3
刊名	JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES
	2021-08-23
关键词	Brain-derived neurotrophic factor Delirium Heparan sulfate Methylprednisolone Syndecan-1 Tumor necrosis factor-alpha
ISSN号	1079-5006
DOI	10.1093/gerona/glab248
通讯作者	Cheng, Xin-qi(ay_mz_cheng@126.com)
英文摘要	Background: Preoperative administration of methylprednisolone reduced circulating markers of endothelial activation. This randomized, double-blind, placebo-controlled trial was to evaluate whether a single preoperative dose of methylprednisolone reduced the rate of postoperative delirium (POD) in older patients undergoing gastrointestinal surgery and its association with the shedding of endothelial glycocalyx markers. Methods: About 168 patients, aged 65-80 years and scheduled for laparoscopic gastrointestinal surgery, were randomized to 2 mg/kg methylprednisolone (Group M, n = 84) or equivalent dose of placebo (Group C, n = 84). The primary outcome was the incidence of delirium during the first 5 days after surgery, assessed by the Confusion Assessment Method (CAM). POD severity was rated daily using CAM-Severity (CAM-S). Levels of syndecan-1, heparan sulfate, tumor necrosis factor-alpha (TNF-alpha), and brain-derived neurotrophic factor (BDNF) were measured at baseline, 1 day, and 3 days after surgery. Results: Compared with placebo, methylprednisolone greatly reduced the incidence of delirium at 72 hours following surgery (9 [10.7%] vs 20 [23.8%], p = .03, OR = 2.22 [95% CI 1.05-4.59]). No between-group difference was found in the cumulative CAM-S score (p = .14). The levels of heparan sulfate, syndecan-1, and TNF-alpha in Group M were lower than that in Group C (p < .05 and p < .01), while the level of BDNF in Group M was higher than that in Group C (p < .01). Conclusions: Preoperative administration of methylprednisolone does not reduce the severity of POD, but may reduce the incidence of delirium after gastrointestinal surgery in older patients, which may be related to a reduction in circulating markers of endothelial degradation, followed by the increase of BDNF level.
资助项目	Natural Science Research Project of Colleges in Anhui Province[KJ2019A0284] ; Zhejiang Province Medical Science and Technology Project[2020KY455]
WOS关键词	ENDOTHELIAL GLYCOCALYX ; ELDERLY-PATIENTS ; RISK-FACTORS ; HYDROCORTISONE ; DYSFUNCTION ; MORTALITY ; BARRIER ; INJURY
WOS研究方向	Geriatrics & Gerontology
语种	英语
出版者	OXFORD UNIV PRESS INC
WOS记录号	WOS:000756632700001
资助机构	Natural Science Research Project of Colleges in Anhui Province ; Zhejiang Province Medical Science and Technology Project
内容类型	期刊论文
源URL	[http://ir.hfcas.ac.cn:8080/handle/334002/127536]
专题	中国科学院合肥物质科学研究院
通讯作者	Cheng, Xin-qi
作者单位	1.Univ Chinese Acad Sci, Dept Anesthesiol, Canc Hosp, Zhejiang Canc Hosp, Hangzhou, Peoples R China 2.Anhui Med Univ, Key Lab Anesthesiol & Perioperat Med Anhui Higher, Hefei, Peoples R China 3.Anhui Med Univ, Dept Anesthesiol, Affiliated Hosp 1, 218 Jixi Rd, Hefei 230022, Anhui, Peoples R China 4.Chinese Acad Sci, Inst Basic Med & Canc IBMC, Hangzhou, Peoples R China
推荐引用方式 GB/T 7714	Xiang, Xiao-bing,Chen, Hao,Wu, Ying-li,et al. The Effect of Preoperative Methylprednisolone on Postoperative Delirium in Older Patients Undergoing Gastrointestinal Surgery: A Randomized, Double-Blind, Placebo-Controlled Trial[J]. JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES,2021.
APA	Xiang, Xiao-bing,Chen, Hao,Wu, Ying-li,Wang, Ke,Yue, Xiang,&Cheng, Xin-qi.(2021).The Effect of Preoperative Methylprednisolone on Postoperative Delirium in Older Patients Undergoing Gastrointestinal Surgery: A Randomized, Double-Blind, Placebo-Controlled Trial.JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES.
MLA	Xiang, Xiao-bing,et al."The Effect of Preoperative Methylprednisolone on Postoperative Delirium in Older Patients Undergoing Gastrointestinal Surgery: A Randomized, Double-Blind, Placebo-Controlled Trial".JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES (2021).