Serum NPTX2 as a Potential Predictive Biomarker for Postoperative Delirium in Patients with Acute Type A Aortic Dissection

Figures & data

Figure 1 The study flowchart, analysis of the association between serum NPTX2 levels and the occurrence of POD, a correlation matrix of variables, and ROC curve analysis. (A) Flow chart of the study. (B) The preoperative serum NPTX2 level was significantly lower in the POD group compared to the Non-POD group. (C) Incidence of POD in relation to quartiles of preoperative serum NPTX2 level. (D) The postoperative serum NPTX2 level was significantly lower in the POD group compared to the Non-POD group. (E) Incidence of POD in relation to quartiles of postoperative serum NPTX2 levels. (F) Correlation matrix of the variables. (G) ROC curve analysis of preoperative and postoperative serum NPTX2 levels for distinguishing POD (n=62). **P < 0.01, ***P < 0.001.

Abbreviations: CPB, cardiopulmonary bypass; Cr, creatinine; DHCA, deep hypothermic circulatory arrest; GERAADA, German Registry of Acute Aortic Dissection Type A; Glu glucose; Hb, hemoglobin; NPTX2, neuronal pentraxin 2; PLT, platelet; POD postoperative delirium; ROC, receiver operating characteristics.

Table 1 Characteristics of Patients with or Without POD

Variables	Total (n= 62)	Non-POD (n = 33)	POD (n = 29)	P value
Demographic
Age (years)	53.13 ± 14.93	49.39 ± 13.67	57.38 ± 15.40	0.036^a
Male, n (%)	52 (83.87)	28 (84.85)	24 (82.76)	1^b
BMI (kg/m2)	26.88 ± 3.76	26.48 ± 4.31	27.33 ± 3.04	0.368^a
Comorbidities
Smoke, n (%)	21 (33.87)	10 (30.30)	11 (37.93)	0.596^b
Alcoholism, n (%)	14 (22.58)	8 (24.24)	6 (20.68)	0.771^b
Hypertension, n (%)	53 (85.48)	28 (84.85)	25 (86.21)	1^b
Diabetes, n (%)	2 (3.23)	1 (3.03)	1 (3.45)	1^b
Atrial Fibrillation	3 (4.84)	2 (6.06)	1 (3.45)	1^b
CAD	3 (4.84)	1 (3.03)	2 (6.90)	0.6^b
PAD	1 (1.61)	1 (3.03)	0 (0)	1^b
CKD	5 (8.06)	3 (9.09)	2 (6.90)	1^b
Risk Prediction Model
EUROSCORE II	1.85 (1.31, 3.10)	1.77 (1.31, 2.25)	2.41 (1.31, 3.87)	0.185^c
GERAADA	13.40 (10.63, 17.53)	12.20 (10.30, 13.60)	16.70 ± 5.67	0.001^c
Surgical details
Aortic root procedure				0.485^b
Untreated, n (%)	52 (83.87)	29 (87.88)	23 (79.31)
Repaired, n (%)	1 (1.61)	0 (0)	1 (3.45)
Bentall procedure, n (%)	8 (12.90)	4 (12.12)	4 (13.79)
Wheat’s procedure, n (%)	1 (1.61)	0 (0)	1 (3.45)
Arch surgery				0.097^b
Untreated, n (%)	3 (4.84)	0 (0)	3 (10.34)
Treated, n (%)	59 (95.16)	33 (100)	26 (89.66)
Other cardiac surgery				0.066^b
Uncombined, n (%)	48 (77.42)	29 (87.88)	19 (65.52)
Combined, n (%)	14 (22.58)	4 (12.12)	10 (34.48)
Duration of surgery (min)	380 (332.50, 450)	360 (315, 390)	410 (360, 460)	0.008^c
CPB time (min)	185.50 (163, 215.25)	174.50 ± 30.34	201 (168, 243)	0.005^c
Aorta cross-clamp time (min)	134.50 (114.75, 174.25)	130.27 ± 29.97	149 (125, 201)	0.008^c
DHCA time (min)	24 (20.25, 29.75)	23 (20, 28)	26.66 ± 6.89	0.047^c
Lowest bladder temperature (°C)	24 (23.25, 24.75)	24 (24, 25)	24 (22, 24)	0.125^c
Preoperative
Total bilirubin (μmol/L)	16.40 (12.77, 22.67)	16.40 (12.30, 23.40)	16.20 (13, 17.20)	0.337^c
Albumin (g/L)	38.45 (36.53, 41.05)	39.50 (36.60, 42)	37.90 (36.50, 39.80)	0.084^c
Glucose (mmol/L)	6.85 (5.90, 8.19)	6.82 ± 1.68	7.10 (6.56, 9.08)	0.036^c
Creatinine (μmol/L)	80.50 (61.82, 110.98)	75 (60.60, 105.40)	97.31 ± 40.51	0.337^c
Na^+ (mmol/L)	140.10 (136.83, 143.75)	140.53 ± 4.46	140.55 ± 5.54	0.987^a
Cl^− (mmol/L)	104.68 ± 4.20	104.79 ± 3.87	104.56 ± 4.61	0.834^a
WBC (10^9/L)	11.82 ± 3.94	11.56 ± 3.58	11.40 (8.50, 14.70)	0.767^c
Hb (g/L)	122.95 ± 22.93	126.70 ± 22.59	118.69 ± 22.96	0.173^a
Platelet (10^9/L)	149.29 ± 63.39	171.61 ± 65.53	123.90 ± 50.90	0.002^a
NPTX2 (pg/mL)	522.81 ± 140.30	567.89 ± 119.29	471.51 ± 146.63	0.006^a
Postoperative
Total bilirubin (μmol/L)	24.35 (15.62, 36.60)	27.20 (14.90, 36.80)	21.00 (15.70, 34.20)	0.662^c
Albumin (g/L)	34.85 (32.58, 36.58)	35.10 (33.20, 37.30)	34.50 (32.50, 36.10)	0.413^c
Glucose (mmol/L)	7.26 (6.17, 8.99)	7.07 (6.11, 8.59)	7.42 (6.50, 9)	0.481^c
Creatinine (μmol/L)	96.50 (70, 128.75)	76 (62, 113)	114 (80, 153)	0.034^c
Na^+ (mmol/L)	144.85 (140.88, 147.40)	143.90 (140.50, 147)	146 (142.40, 148.90)	0.133^c
Cl^− (mmol/L)	109.20 (105.95, 111.28)	107.30 (104.20, 110.90)	109.60 (106.90, 112.30)	0.062^c
WBC (10^9/L)	11.25 (8.93, 14.32)	10.70 (9.10, 14.10)	11.40 (8.50, 14.70)	0.767^c
Hb (g/L)	95.60 ± 14.64	99.97 ± 12.51	90.62 ± 15.49	0.011^a
Platelet (10^9/L)	90.50 (72.25, 119.25)	101 (83, 124)	85 (58, 111)	0.064^c
NPTX2 (pg/mL)	456.21 ± 127.61	529.34 ± 115.94	373.01 ± 81.52	<0.001^a
CRP (mg/L)	140.51 ± 66.08	138.39 ± 62.17	142.92 ± 71.31	0.79^a

Notes: ^aIndependent t-tests; ^bChi-squared or Fisher’s exact test; ^cmann–Whitney U-test. Bold numerical text: P<0.05.

Abbreviations: POD, postoperative delirium; BMI, body mass index; CAD, coronary artery disease; PAD, peripheral artery disease; CKD, chronic kidney disease; EUROSCORE II, European System for Cardiac Operative Risk Evaluation II; GERAADA, German Registry of Acute Aortic Dissection Type A; CPB, cardiopulmonary bypass; DHCA, deep hypothermic circulatory arrest; WBC, white blood cell count; Hb, hemoglobin; NPTX2, neuronal pentraxins 2; CRP, C-reactive protein.

Table 2 Multivariate Logistic Regression Analysis of POD Risk Factors

Variable	Coefficient	Odds Ratio (95% CI)	P value
Preoperative NPTX2	−0.009	0.991 (0.984,0.999)	0.022
Postoperative NPTX2	−0.088	0.916 (0.856, 0.981)	0.012

Notes: Adjusted for: age, GERAADA scores, duration of surgery, DHCA time, preoperative glucose, preoperative platelet, Postoperative creatinine, and postoperative Hb.

Abbreviations: NPTX2, neuronal pentraxin 2; GERAADA, German Registry of Acute Aortic Dissection Type A; DHCA, deep hypothermic circulatory arrest; Hb hemoglobin.