Preoperative serum ribose concentrations may be associated with postoperative delirium in older patients with a hip fracture.

BACKGROUND:Postoperative delirium (POD) is a common postoperative neurocognitive complication, especially in older patients. However, satisfactory biomarkers for predicting individual risks of POD have not been confirmed. D-ribose involvement in protein glycation and aggregation plays a pivotal role in age-related neurodegenerative disorders such as Alzheimer's disease. OBJECTIVES:This study aimed to determine whether serum D-ribose concentrations contribute to the early diagnosis of POD. We also discuss the probable mechanisms underlying the development of POD. METHODS:110 older patients with hip fracture who had undergone internal fixation or hip replacement under general anesthesia and had completed our assessments were selected. Preoperative venous blood (4 ml) was collected before the induction of anesthesia. Postoperative venous blood was obtained at 07:00 and 20:00 h on postoperative day 1 and at 20:00 h on postoperative day 2. On the first 2 postoperative days, the patients were assessed twice daily (at 8:00 and 20:00 h on each day) using the Confusion Assessment Method-Chinese Revision. RESULTS:15 patients were finally diagnosed with POD. We also included 15 patients without POD who were matched with the recruited patients with POD (1:1) on the basis of age, sex, body mass index and the Mini-Mental State Examination score. Serum ribose concentrations were measured by high-performance liquid chromatography. The demographic characteristics of the groups were matched. Preoperative serum ribose concentrations were significantly higher in patients with POD than in those without POD (p < 0.05) and were also an independent risk factor for POD. Moreover, when the preoperative serum ribose concentration doubled, the risk of POD increased by 1.672 times. CONCLUSIONS:These results indicate that the serum D-ribose concentration may be a potential predictive molecular biomarker for POD, and provide useful information for further pathological mechanism studies.