Serum high-mobility group box 1 protein correlates with cognitive decline after gastrointestinal surgery

• Published in: Acta anaesthesiologica Scandinavica 2014-07, Vol.58 (6), p.668-674
• Main Authors: LIN, G.-X., WANG, T., CHEN, M.-H., HU, Z.-H., OUYANG, W.
• Format: Article
• Language: English
• Subjects: Aged; Anesthesia, General; Biomarkers; Cognition Disorders - blood; Cognition Disorders - diagnosis; Cognition Disorders - etiology; Cognitive Reserve; Digestive System Surgical Procedures; Educational Status; Elective Surgical Procedures; Female; Gastrointestinal Neoplasms - surgery; Gastrointestinal surgery; HMGB1 Protein - blood; Humans; Inflammation - blood; Interleukin-6 - blood; Liver Neoplasms - surgery; Male; Medical research; Middle Aged; Neuropsychological Tests; Postoperative Complications - blood; Postoperative Complications - diagnosis; Postoperative Complications - etiology; Postoperative Complications - psychology; Prospective Studies; Starvation
• ISSN: 0001-5172; 1399-6576
• DOI: 10.1111/aas.12320

Background Accumulating evidence has indicated that inflammation may act as a potential mechanism underlying post‐operative cognitive dysfunction (POCD). High‐mobility group box 1 (HMGB1), as a known late mediator of inflammation, is involved in the development of post‐operative complications. Thus, we sought to determine the role of HMGB1 in reflecting POCD following major gastrointestinal surgery. Methods Fifty‐three elderly patients undergoing gastrointestinal surgery were recruited, and 50 patients completed the study. Serum HMGB1 and interleukin (IL)‐6 levels were measured pre‐operatively and at 6 h, day 1 and day 3 post‐operatively. Neuropsychological tests were administered before and 1 week after surgery. POCD was determined using a Z score ≥ 1.96. Results Seventeen (34%, 17/50) patients developed POCD at 1 week. The POCD group had higher serum HMGB1 levels at day 1 (12.15 ± 3.12 vs. 9.91 ± 3.15 ng/ml, P = 0.021) and day 3 (11.04 ± 2.88 vs. 8.52 ± 3.31 ng/ml, P = 0.011). IL‐6 levels at 6 h (51.18 ± 15.22 vs. 39.20 ± 14.32 pg/ml, P = 0.009) and day 1 (41.59 ± 11.08 vs. 33.81 ± 11.42 pg/ml, P = 0.026) were significantly higher in POCD patients. Serum values of IL‐6 at 6 h, HMGB1 at day 1 and levels of education showed positive correlations with Z scores. HMGB1 at day 3 and IL‐6 at 6 h were independent risk factors. Conclusions Serum HMGB1 and IL‐6 levels increase significantly after major gastrointestinal surgery in elderly patients and such elevations are associated with the occurrence of cognitive decline after surgery.