Imagine you’re predicting the outcome of a race, but instead of just looking at how fast the runners are, you also take into account their favorite color. That’s what researchers did in this study on postoperative delirium. They wanted to compare two biomarkers, homocysteine and C-reactive protein (CRP), to see which one was better at predicting delirium after surgery. They found that while CRP was associated with delirium incidence and severity, the relationship was modified by preoperative homocysteine levels. Basically, depending on how much homocysteine was in a person’s blood before surgery, the link between CRP and delirium varied. These findings suggest that biomarkers may be even more valuable when considered together rather than individually. It’s like using multiple puzzle pieces to create a clearer picture. Further research is needed to validate these results and understand the precise mechanisms behind the interaction. For now, though, it’s an exciting step toward improving our ability to predict and prevent postoperative delirium!

BackgroundHomocysteine and C-reactive protein (CRP) may serve as biomarkers of postoperative delirium. We set out to compare the role of blood concentration of homocysteine versus CRP in predicting postoperative delirium in patients.Materials and methodsIn this prospective observational cohort study, the plasma concentration of preoperative homocysteine and postoperative CRP was measured. Delirium incidence and severity within 3 days postoperatively were determined using the Confusion Assessment Method and Confusion Assessment Method-Severity algorithm.ResultsOf 143 participants [69% female, median (interquartile range, 25th–75th) age of 71 (67–76) years] who had knee or hip surgery under general anesthesia, 44 (31%) participants developed postoperative delirium. Postoperative plasma concentration of CRP was associated with postoperative delirium incidence [adjusted odds ratio (OR) per one standard deviation change in CRP: 1.51; 95% Confidence Interval (CI): 1.05, 2.16; P = 0.026], and severity [in which each one standard deviation increase in postoperative CRP was associated with a 0.47 point (95% CI: 0.18–0.76) increase in the severity of delirium, P = 0.002] after adjusting age, sex, preoperative Mini-Mental State Examination score and the days when postoperative CRP was measured. A statistically significant interaction (adjusted P = 0.044) was also observed, in which the association between postoperative plasma concentration of CRP and postoperative delirium incidence was stronger in the participants with lower preoperative plasma concentrations of homocysteine compared to those with higher preoperative levels.ConclusionPending validation studies, these data suggest that preoperative plasma concentration of homocysteine modifies the established association between postoperative plasma concentration of CRP and postoperative delirium incidence.

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