Production of inflammatory cytokines, cortisol, and Aβ1-40 in elderly oral cancer patients with postoperative delirium

Figures & data

Table 1 Demographic characteristics of the POD and NPOD groups

Characteristic	POD (n=56)	NPOD (n=56)	P-value
Age (years)	73.2±6.5	72.7±8.3	0.72
Female	29	33	0.57
Weight (kg)	60±15	63±16	0.31
Education (years)	8.2±2.3	8.5±2.8	0.54
ASA grade (I/II/III)	9/41/5	15/36/6	0.40
MMSE score at T0	27.91±1.53	28.13±1.62	0.46
Charlson’s Comorbidity Index at T0	1.5±0.7	1.7±0.8	0.16
Flap reconstruction			0.36
Forearm	25	24
Anterolateral thigh	20	15
Peroneal muscles	11	17
Operation duration (min)	481±102	470±108	0.58
Anesthesia duration (min)	515±97	506±104	0.64
Blood loss (mL)	802±211	785±203	0.66
RBC transfusion (units)	2.6±1.8	2.1±1.9	0.16
FFP transfusion (units)	2.2±1.6	1.8±1.5	0.18
Volume of infusion (mL)	3,612.0±613.9	3,498.5±656.5	0.35

Note: Data are shown as mean ± SD or numbers.

Abbreviations: ASA, American Society of Anesthesiologists; FFP, fresh frozen plasma; MMSE, Mini-Mental State Examination; NPOD, no POD; POD, postoperative delirium; RBC, red blood cells; SD, standard deviation; min, minutes; T0, prior to surgery.

Figure 1 The added morbidity of postoperative delirium (POD) days 1–3.

Note: The added morbidity of POD on postoperative day 3 was lower than that on postoperative days 1 (P<0.01) and 2 (P=0.01).

Figure 2 The type of postoperative delirium (POD).

Notes: Among the 56 patients with POD, 38 patients were diagnosed with hyperactive delirium, seven with hypoactive delirium, and eleven with mixed delirium.

Figure 3 Concentration of interleukin (IL)-6 between the NPOD and POD groups.

Notes: There were no significant differences in the IL-6 levels between the two groups prior to surgery (T0) (P=0.60). At the end of surgery (T1) and 12 h after surgery (T2), the IL-6 levels were higher in the POD than that in NPOD group (P<0.01). At T1 and T2, the levels of IL-6 in each group were higher than those in the corresponding group at T0 (P<0.05).
Abbreviations: NPOD, no POD; POD, postoperative delirium; h, hours.

Figure 4 Concentration of CRP between the NPOD and POD groups.

Notes: There were no significant differences in the CRP levels between the two groups prior to surgery (T0) (P=0.55) and at the end of surgery (T1) (P=0.50). Furthermore, the CRP levels in each group at T1 were not different from those in the corresponding group at T0 (P>0.05). However, 12 h after surgery (T2), the CRP levels were higher in the POD than that in NPOD group (P<0.01). At T2, the levels of CRP in each group were higher than those in the corresponding group at T0 (P<0.05).
Abbreviations: CRP, C-reactive protein; NPOD, no POD; POD, postoperative delirium; h, hours.

Figure 5 Concentration of PCT between the NPOD and POD groups.

Notes: There were no significant differences in the PCT levels between the two groups prior to surgery (T0) (P=0.14). At the end of surgery (T1) and 12 h after surgery (T2), the PCT levels were higher in the POD than that in NPOD group (P=0.02 and P<0.01). At T1 and T2, the levels of PCT in each group were higher than those in the corresponding group at T0 (P<0.05).
Abbreviations: NPOD, no POD; POD, postoperative delirium; PCT, procalcitonin; h, hours.

Figure 6 Concentration of cortisol between the NPOD and POD groups.

Notes: There were no significant differences in the cortisol levels between the two groups prior to surgery (T0) (P=0.15). At the end of surgery (T1) and 12 h after surgery (T2), the cortisol levels were higher in the POD than that in NPOD group (P<0.01). At T1 and T2, the levels of cortisol in each group were higher than those in the corresponding group at T0 (P<0.05).
Abbreviations: NPOD, no POD; POD, postoperative delirium; h, hours.

Figure 7 Concentration of Aβ1-40 between the NPOD and POD groups.

Notes: There were no significant differences in the Aβ1-40 levels between the two groups prior to surgery (T0) (P=0.17) and at the end of surgery (T1) (P=0.12). Furthermore, the Aβ1-40 levels in each group at T1 were not different from those in the corresponding group at T0 (P>0.05). However, 12 h after surgery (T2), the Aβ1-40 levels were higher in the POD than that in NPOD group (P<0.01). At T2, the levels of Aβ1-40 in each group were higher than those in the corresponding group at T0 (P<0.05).
Abbreviations: Aβ1-40, amyloid β1-40; NPOD, no POD; POD, postoperative delirium; h, hours.

Figure 8 MMSE scores of the NPOD and POD groups during the perioperative period.

Note: No differences in the MMSE scores were found between the two groups at T0 (P=0.46), but the MMSE scores after surgery were lower in the POD than that in NPOD group (P<0.01).
Abbreviations: MMSE, Mini-Mental State Examination; NPOD, no POD; POD, postoperative delirium; T0, prior to surgery.