Preoperative biofluid biomarkers reflecting pathophysiological, neuronal injury, and inflammation as well as those for Alzheimer's disease (AD) may be valuable tools for the risk stratification of perioperative neurocognitive disorders (PNDs) in older adults. We summarized current evidence relating these preoperative biomarkers to PND beyond 7 days, in older surgical participants aged ≥60 years. Studies that evaluated the association of preoperative biomarkers with cognitive decline as an outcome, beyond 7 days, were identified through searches of 6 databases and 3 trial registries to 17 January 2024. Preclinical studies, intracranial surgical, or studies with participants aged <60 years were excluded. Studies varied widely in the assessment of PND, so a wide range of cognitive outcomes was accepted, including those using the term postoperative cognitive dysfunction (POCD) to define cognitive decline. The pooled incidence of POCD utilizing a binary cognitive outcome was summarized. Fifteen studies involving 2103 participants were included. Marked heterogeneity was evident in the cognitive outcome metrics, assessment timeframes, limiting a quantitative synthesis. Of the 9 studies using binarized cognitive outcomes, the incidence of POCD was 23.4% (95% confidence interval [CI], 6.6-46.2) at <3 months, 11.4% (95% CI, 8.1-15.0) at 3 to <12 months, and 6.9% (95% CI, 1.9-14.5) at ≥12 months postoperatively. Of the 15 studies, 9 described blood-based biomarkers, 4 described cerebrospinal fluid (CSF) biomarkers, and 2 measured both blood and CSF markers. The biomarkers evaluated reflected the pathogenic indicators neuronal injury (9 studies), inflammation (5 studies) and of amyloid (5 studies), and Tau (1 study). The studies included were of medium to high quality. Evidence was the most promising for amyloid biomarkers, with 4 of 5 included studies demonstrating associations of lower preoperative biofluid amyloid biomarker levels with increased risk of POCD. In conclusion, preoperative biofluid amyloid biomarkers may hold potential utility for the prediction of POCD, although current evidence remains limited. Other potential preoperative biomarkers for POCD included p-Tau181 and Neurofilament Light, however small sample sizes, study heterogeneity, and conflicting results limited conclusions drawn. Standardized cognitive outcome metrics and common assessment timeframes are additionally required in future studies to ascertain the prognostic utility of these biomarkers for POCD.

中文翻译：

---

预测老年人术后神经认知障碍的术前生物流体生物标志物：系统评价。


反映病理生理学、神经元损伤和炎症以及阿尔茨海默病 （AD） 的术前生物流体生物标志物可能是老年人围手术期神经认知障碍 （PND） 风险分层的宝贵工具。我们总结了在 60 岁的老年手术参与者中将这些术前生物标志物与 7 天后 PND 相关的当前证据≥。通过检索 6 个数据库和 3 个试验注册库，确定了截至 2024 年 1 月 17 日，评估术前生物标志物与 7 天后认知能力下降结局关联的研究。临床前研究、颅内手术或参与者年龄 <60 的研究被排除在外。在 PND 评估方面的研究差异很大，因此接受了广泛的认知结局，包括使用术语术后认知功能障碍 （POCD） 来定义认知能力下降的结局。总结了利用二元认知结果的 POCD 的汇总发生率。共纳入 15 项研究，涉及 2103 名参与者。在认知结果指标、评估时间框架方面存在明显的异质性，限制了定量综合。在使用二值化认知结局的 9 项研究中，POCD 的发生率在 <3 个月为 23.4% （95% 置信区间 [CI]，6.6-46.2），在 3 至 <12 个月为 11.4% （95% CI，8.1-15.0），术后 ≥ 12 个月为 6.9% （95% CI，1.9-14.5）。在这 15 项研究中，9 项描述了基于血液的生物标志物，4 项描述了脑脊液 （CSF） 生物标志物，2 项同时测量了血液和 CSF 标志物。评估的生物标志物反映了致病指标神经元损伤 （9 项研究） 、炎症 （5 项研究） 和淀粉样蛋白 （5 项研究） 和 Tau （1 项研究）。纳入的研究质量为中到高质量。 淀粉样蛋白生物标志物的证据最有希望，5 项研究中有 4 项表明术前生物流体淀粉样蛋白生物标志物水平较低与 POCD 风险增加之间存在关联。总之，术前生物流体淀粉样蛋白生物标志物可能对预测 POCD 具有潜在效用，尽管目前的证据仍然有限。POCD 的其他潜在术前生物标志物包括 p-Tau181 和 Neurofilament Light，但样本量小、研究异质性和相互矛盾的结果限制了得出的结论。未来的研究还需要标准化的认知结果指标和通用的评估时间表，以确定这些生物标志物对 POCD 的预后效用。