Serum Uric Acid as a Predictor for Delirium After Knee Replacement Surgery

Published on July 14, 2022

Imagine you have a magic crystal ball that can predict whether or not you’ll experience delirium after knee replacement surgery. Well, researchers have found that one potential crystal ball could be your preoperative serum uric acid (SUA) level. In a study exploring the link between SUA and postoperative delirium (POD) in geriatric patients, they discovered that those with elevated SUA levels were more likely to develop POD. But how does this work? It turns out that high SUA may increase the level of cerebrospinal fluid (CSF) phosphorylated tau (P-tau), an Alzheimer-related biomarker associated with POD. This means that high SUA could enhance the risk of developing delirium. In fact, the researchers developed a predictive model that combined SUA and Alzheimer-related biomarkers, resulting in an accurate tool for predicting the occurrence of POD. So, if you’re curious about how your preoperative SUA level might affect your risk of delirium after knee replacement surgery, check out the underlying research!

ObjectivesThe relationship between preoperative serum uric acid (SUA) and cerebrospinal fluid (CSF) Alzheimer-related biomarkers were investigated to determine whether high SUA is a potential risk factor for postoperative delirium (POD) and to evaluate its predictive efficacy.MethodsThe participants were selected from the Perioperative Neurocognitive Disorder Risk Factor and Prognosis (PNDRFAP) study and the Perioperative Neurocognitive Disorder and Biomarker Lifestyle (PNDABLE) study. The logistic regression equation was used to analyze the risk factors and protective factors of POD. The interaction term (SUA × Sex) was introduced into the linear model to explore the potential modification effects of sex on the identified correlations. We analyzed the mediating effects of Alzheimer-related biomarkers. Finally, we constructed the receiver operating characteristic (ROC) curve and the nomogram model to evaluate the efficacy of SUA and Alzheimer-related biomarkers in predicting POD.ResultsPatients with POD had elevated SUA level (PNDRFAP: p = 0.002, PNDABLE: p < 0.001). Preoperative SUA level was positively correlated with CSF phosphorylated tau (P-tau) (p = 0.027) and β-amyloid42 (Aβ42)/P-tau (p = 0.023). Interaction analysis did not find any modification effect of sex. The relationship between SUA and POD was partially mediated by CSF P-tau (15.3%). ROC curve showed that the model combining SUA and Alzheimer-related biomarkers had better performance in predicting POD [area under the curve (AUC) = 0.880; p < 0.001], and the predictive model is accurate.ConclusionsHigh SUA may enhance CSF P-tau level, thus increasing the risk of POD, and the model combining SUA and Alzheimer-related biomarkers can accurately predict the occurrence of POD.

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