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A case series on the value of tau and neurofilament protein levels to predict and detect delirium in cardiac surgery patients

Journal article
Authors T. Saller
A. Petzold
Henrik Zetterberg
J. Kuhle
D. Chappell
V. von Dossow
F. Klawitter
T. Schurholz
C. Hagl
D. A. Reuter
B. Zwissler
J. Ehler
Published in Biomedical Papers-Olomouc
Volume 163
Issue 3
Pages 241-246
ISSN 1213-8118
Publication year 2019
Published at Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry
Pages 241-246
Language en
Keywords cardiac surgery, neuroinflammation, delirium, biomarker, neurofilaments, tau protein, fibrillary acidic protein, biomarker, markers, injury, elisa, Engineering, Research & Experimental Medicine
Subject categories Clinical Medicine


Background. Delirium following cardiac surgery is a relevant complication in the majority of elderly patients but its prediction is challenging. Cardiopulmonary bypass, essential for many interventions in cardiac surgery, is responsible for a severe inflammatory response leading to neuroinflammation and subsequent delirium. Neurofilament light protein (NfL) and tau protein (tau) are specific biomarkers to detect neuroaxonal injury as well as glial fibrillary acidic protein (GFAP), a marker of astrocytic activation. Methods. We thought to examine the perioperative course of these markers in a case series of each three cardiac surgery patients under off-pump cardiac arterial bypass without evolving delirium (OPCAB-NDEL), patients with a procedure under cardio-pulmonary bypass (CPB) without delirium (CPB-NDEL) and delirium after a CPB procedure (CPB-DEL). Delirium was diagnosed by the Confusion Assessment Method for the ICU and chart reviews. Results. We observed increased preoperative levels of tau in patients with later delirium, whereas values of NfL and GFAP did not differ. In the postoperative course, all biomarkers increased multi-fold. NfL levels sharply increased in patients with CPB reaching the highest levels in the CPB-DEL group. Conclusion. Tau and NfL might be of benefit to identify patients in cardiac surgery at risk for delirium and to detect patients with the postoperative emergence of delirium.

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