The Association of Plasma Leptin, Soluble Leptin Receptor and Total and High-Molecular Weight Adiponectin With the Risk of Perioperative Neurocognitive Disorders

• Published in: The American journal of geriatric psychiatry 2024-09, Vol.32 (9), p.1119-1129
• Main Authors: Feinkohl, Insa, Janke, Jürgen, Slooter, Arjen J.C., Winterer, Georg, Spies, Claudia, Pischon, Tobias
• Format: Article
• Language: English
• Subjects: Adiponectin; Adiponectin - blood; Aged; Aged, 80 and over; Biomarkers - blood; epidemiology; Female; Humans; leptin; Leptin - blood; Male; Neurocognitive Disorders - blood; Neurocognitive Disorders - etiology; Perioperative Period; Postoperative Cognitive Complications - blood; Postoperative Cognitive Complications - epidemiology; postoperative cognitive dysfunction; Postoperative Complications - blood; Postoperative Complications - epidemiology; postoperative delirium; Prospective Studies; Receptors, Leptin - blood; Risk Factors
• ISSN: 1064-7481; 1545-7214; 1545-7214
• DOI: 10.1016/j.jagp.2024.03.015

•What is the primary question addressed by this study?In the largest study on the topic to date, we examined preoperative adipokine concentrations in circulation and the risks of postoperative delirium (POD) and cognitive dysfunction (POCD).•What is the main finding of this study?Lower free leptin was associated with an increased risk of POD during the hospital stay, although due to a large number of statistical analyses, we cannot rule out an influence of type I error.•What is the meaning of the finding?We present preliminary evidence for low leptin as a potential risk factor for POD. Perioperative neurocognitive disorders (NCD) are poorly characterized in terms of their risk factor profiles. Leptin and adiponectin are adipose-tissue-derived hormones with a role in inflammation and atherosclerosis whose function in perioperative NCD is unclear. Here, we used a cohort of older adults to examine the association of preoperative plasma concentrations of these biomarkers with the risk of perioperative NCD. Prospective analysis of 768 participants aged ≥ 65 years of the BioCog study. Blood was collected before surgery for measurement of plasma total and high-molecular-weight (hmw) adiponectin, leptin, and soluble leptin receptor (sOB-R). The free leptin index (FLI, leptin:sOB-R) was calculated. Postoperative delirium (POD) was assessed twice daily until postoperative day 7/discharge. Five hundred twenty-six patients (68.5%) returned for 3-month follow-up and provided data on postoperative cognitive dysfunction (POCD). POCD was defined as a decline on six neuropsychological tests that exceeded that of a nonsurgical control group. Logistic regression analyses examined the associations of each exposure with POD and POCD risk, in separate models adjusted for age, sex, fasting, surgery type, and body mass index (BMI). Of 768 patients, 152 (19.8%) developed POD. Of 526 attendants of the follow-up, 54 (10.3%) had developed POCD. Leptin, sOB-R, and total and hmw adiponectin were each not associated with POD. For POCD, we observed reduced risk in patients in FLI quartile 4 compared with quartile 1 (odds ratio, 0.26; 95% CI 0.08, 0.89). Sensitivity analyses for the outcome POD revealed statistically significant interaction terms of sOB-R and total adiponectin with obesity (BMI≥30kg/m2 versus BMI