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Inflammation but not Glycemic Control is Associated with Neurocognitive Decline After Cardiac Surgery
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  • Laura Scrimgeour,
  • Ian Ikeda,
  • Nicholas Sellke,
  • Guangbin Shi,
  • Jun Feng,
  • Sevdenur Cizginer,
  • Afshin Ehsan,
  • Neel Sodha,
  • Frank Sellke
Laura Scrimgeour
Brown University
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Ian Ikeda
Brown University
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Nicholas Sellke
Brown University
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Guangbin Shi
Brown University
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Jun Feng
Brown University
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Sevdenur Cizginer
Brown University
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Afshin Ehsan
Brown University Warren Alpert Medical School
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Neel Sodha
Brown University
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Frank Sellke
Brown University
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Abstract

Background: Whether perioperative glycemic control or markers of inflammation is associated with neurocognitive decline (NCD) after cardiac surgery was examined. Methods: Thirty patients undergoing cardiac surgery utilizing cardiopulmonary bypass (CPB) were screened for NCD preoperatively and on post-operative day four (POD4). Serum cytokine levels were measured and human transcriptome analysis was performed on blood samples. Neurocognitive data are presented as a change from baseline to POD4 in a score standardized with respect to age and gender. Results: A decline in neurocognitive function was identified in 73% (22/30) of patients on POD4. Patients with postoperative leukocytosis (WBC ≥ 10.5) had more NCD when compared to their baseline function (p=0.03). Patients with elevated IL-8 levels at 6 hours postoperatively had a significant decline in NCD at POD4 (p=0.04). Surprisingly, TNF-α, IL-1β, IL-2, or IL-6 levels were not associated with NCD (p>0.3 for all). There was no difference in neurocognitive function between patients with elevated HbA1c levels preoperatively (p=0.973) or elevated fasting blood glucose levels the morning of surgery (>126mg/dL, p=0.910), or a higher maximum blood glucose levels during CPB (>180mg/dL, p=0.252), or higher average glucose levels during CPB (>160mg/dL, p=0.639). Human transcriptome analysis demonstrated unique and differential patterns of gene expression in patients depending on the presence of DM and NCD. Conclusions: Perioperative glycemic control does not have an effect on NCD soon after cardiac surgery. Postoperative leukocytosis and elevated IL-8 levels are associated with neurocognitive decline. The profile of gene expression was altered in patients with NCD with or without diabetes.

Peer review status:ACCEPTED

07 Jun 2021Submitted to Journal of Cardiac Surgery
08 Jun 2021Submission Checks Completed
08 Jun 2021Assigned to Editor
12 Jun 2021Reviewer(s) Assigned
27 Jul 2021Review(s) Completed, Editorial Evaluation Pending
30 Jul 2021Editorial Decision: Revise Major
13 Aug 20211st Revision Received
14 Aug 2021Submission Checks Completed
14 Aug 2021Assigned to Editor
14 Aug 2021Reviewer(s) Assigned
21 Sep 2021Review(s) Completed, Editorial Evaluation Pending
22 Sep 2021Editorial Decision: Accept