Preoperative Plasma p-tau231, p-tau181, and p-tau217 Are Associated With Postoperative Delirium: A Prospective Study.
Summary
In a prospective cohort of 172 older adults undergoing laparoscopic surgery, higher preoperative plasma p‑tau181, p‑tau217, p‑tau231, and T‑tau were independently associated with postoperative delirium. p‑tau231 showed the best discrimination (AUC 0.966; sensitivity 0.90; specificity 0.967), outperforming other tau measures and correlating with delirium severity.
Key Findings
- Postoperative delirium incidence was 12% (20/172).
- Preoperative p‑tau181 (OR 1.05), p‑tau217 (OR 1.02), p‑tau231 (OR 1.09), and T‑tau (OR 1.01) were independently associated with delirium after adjustment.
- p‑tau231 achieved the highest AUC (0.966), with sensitivity 0.900 and specificity 0.967, outperforming p‑tau181, p‑tau217, and T‑tau.
Clinical Implications
Preoperative p‑tau231 testing could be incorporated into risk stratification for older surgical patients to trigger delirium prevention bundles (e.g., multimodal analgesia, sleep promotion, anticholinergic avoidance) and inform anesthetic plans.
Why It Matters
This work identifies a feasible blood biomarker—p‑tau231—for preoperative prediction of delirium, a common and morbid perioperative complication. It offers a pathway toward targeted prevention strategies and personalized anesthetic care.
Limitations
- Single‑center study with a modest sample size may limit generalizability.
- Population restricted to older adults undergoing laparoscopic surgery; external validation and calibration needed.
Future Directions
Multicenter validation with predefined cutoffs; integration into comprehensive delirium risk models; interventional trials to test biomarker‑guided prevention strategies.
Study Information
- Study Type
- Cohort
- Research Domain
- Diagnosis
- Evidence Level
- II - Prospective observational cohort demonstrating strong associations with adjusted analyses.
- Study Design
- OTHER