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We studied the cerebrospinal fluid (CSF) and serum biochemical inflammatory response to a standardized orthopedic surgical procedure and the possible association with long\u2010term changes in cognitive function. We hypothesized that the CSF inflammatory response pattern after surgery would differ in patients having long\u2010term cognitive decline defined as a composite cognitive\n                      <jats:italic>z<\/jats:italic>\n                      score of \u22651.0 compared to patients without long\u2010term cognitive decline at 3 months postsurgery.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Serum and CSF biomarkers of inflammation and blood\u2013brain barrier (BBB) integrity were measured preoperatively and up to 48 hours postoperatively, and cognitive function was assessed preoperatively and at 2 to 5\u2009days and 3 months postoperatively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Surgery was associated with a pronounced increase in inflammatory biomarkers in both CSF and blood throughout the 48\u2010hour study period. A principal component (PC) analysis was performed on 52 inflammatory biomarkers. The 2 first PC (PC1 and PC2) construct outcome variables on CSF biomarkers were significantly associated with long\u2010term cognitive decline at 3 months, but none of the PC construct serum variables showed a significant association with long\u2010term cognitive decline at 3 months. Patients both with and patients without long\u2010term cognitive decline showed early transient increases of the astroglial biomarkers S\u2010100B and glial fibrillary acidic protein in CSF, and in BBB permeability (CSF\/serum albumin ratio).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interpretation<\/jats:title>\n                    <jats:p>\n                      Surgery rapidly triggers a temporal neuroinflammatory response closely associated with long\u2010term cognitive outcome postsurgery. The findings of this explorative study require validation in a larger surgical patient cohort.\n                      <jats:bold>Ann Neurol 2020;87:370\u2013382<\/jats:bold>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ana.25678","type":"journal-article","created":{"date-parts":[[2020,1,12]],"date-time":"2020-01-12T22:49:07Z","timestamp":1578869347000},"page":"370-382","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":65,"title":["Neuroinflammatory markers associate with cognitive decline after major surgery: Findings of an explorative study"],"prefix":"10.1002","volume":"87","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9609-5352","authenticated-orcid":false,"given":"Mattias","family":"Danielson","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Intensive Care Medicine Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska 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