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Dementia and CSF-biomarkers for Alzheimer's disease predict mortality after acute hip fracture

Artikel i vetenskaplig tidskrift
Författare Robert Dutkiewicz
Henrik Zetterberg
Ulf Andreasson
Kaj Blennow
Bengt Nellgård
Publicerad i Acta Anaesthesiologica Scandinavica
Sidor 11
ISSN 0001-5172
Publiceringsår 2019
Publicerad vid Institutionen för neurovetenskap och fysiologi
Institutionen för kliniska vetenskaper, Avdelningen för anestesiologi och intensivvård
Institutionen för neurovetenskap och fysiologi, sektionen för psykiatri och neurokemi
Sidor 11
Språk en
Länkar dx.doi.org/10.1111/aas.13472
Ämnesord cerebrospinal-fluid, cognitive impairment, blood biomarkers, risk, surgery, tau, stability, markers, frailty, people, Anesthesiology
Ämneskategorier Anestesiologi

Sammanfattning

Background Mortality is high after an acute hip fracture (AHF) surgery. Are cognitive impairment and/or altered levels of Alzheimer's Disease (AD)-biomarkers in cerebrospinal fluid (CSF) predictors of mortality in AHF-patients, as retrospective studies indicate? Methods Prospective single-center study including 373 AHF-patients, operated in spinal anesthesia. Cognitive status was evaluated by clinical dementia rating (CDR); CSF was analyzed for AD-biomarker concentrations (total tau (T-tau), phosphorylated tau (P-tau), amyloid beta ratio (A beta 42/A beta 40). CDR and biomarker levels were related to mortality up to one-year post-surgery, using univariate logistic regression analysis. Results Survival analyses showed that mortality was associated to the degree of dementia. In the entire patient cohort 30-, 90-, and 365-day mortality rates were 7.2%, 15.5%, and 25.5%, respectively, but only 2.7%, 5.5%, and 12.6%, for cognitively intact vs 16.3%, 31.7%, and 42.3% for demented patients (OR = 2.2-2.8 [CI = 1.6-4.9]; P = .0001). High CSF T-tau (OR = 1.19 [CI = 1.05-1.33]; P = .004) and low A beta 42/A beta 40-ratio (OR = 0.85 [CI = 0.74-0.97]; P = .017) were associated with increased 90-day mortality. Analysis of 4 subgroups (Cognitive impairment +/- and Biomarkers +/-) showed significant associations of dementia and CSF biomarker concentrations to mortality after an AHF. Even cognitively intact patients presenting with abnormal AD-biomarkers showed an increased 90-day mortality which, however, was statistically insignificant. Conclusions Cognitive impairment and altered CSF biomarker concentrations indicative of AD pathology can predict increased mortality in patients with an AHF, and so probably even before clinical dementia diagnosis by early biomarker analysis; a notion that may have substantial clinical implications by improving perioperative treatment and postoperative rehabilitation.

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