Insulin Resistance Predicts Postoperative Cognitive Dysfunction in Elderly Gastrointestinal Patients

Published on August 9, 2019

BACKGROUND: Aging population undergoing surgery are at risk of postoperative cognitive dysfunction (POCD). Exploring effective and reliable early predictor of POCD is essential to identify high-risk patients and make prospective decisions. The purpose of this study was to examine whether preoperative insulin resistance, is an independent predictor of POCD.
METHODS: A total of 124 aged 60 years older patients for gastrointestinal surgery were enrolled in a prospective observational clinical study. All participants completed a battery of neuropsychological tests before surgery and at 7 days afterwards. POCD was defined as a decline of at least 1.5 SD on two or more of neuropsychological tests. Plasma concentration of tumor necrosis factor α (TNF-α), C-reactive protein (CRP), and S-100β protein were measured. The status of insulin resistance was assessed by Homeostasis Model Assessment–Insulin Resistance (HOMA-IR). The relationship between HOMA-IR and POCD was assessed by Multivariable logistic regression models and the receiver operating characteristic curve.

RESULTS: 51 patients (41.1%) were diagnosed with POCD at 7 days after surgery. Preoperative HOMA-IR values of the POCD group were significantly higher than the non-POCD group, besides, CRP and TNF-α levels of the POCD group were significantly higher at each postoperative time point (P2.6) had a three time’s higher risk of POCD (OR 3.26; 95% CI 1.07–9.91) compared individuals below the threshold. The areas under the receiver operating characteristic curve of HOMA-IR was 0.804 (95% CI, 0.725–0.883; P

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