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Young Award"],"award-info":[{"award-number":["William L. Young Award"]}],"id":[{"id":"10.13039\/100014351","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Annals of Neurology"],"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Although animal models suggest a role for blood\u2013brain barrier dysfunction in postoperative delirium\u2010like behavior, its role in postoperative delirium and postoperative recovery in humans is unclear. Thus, we evaluated the role of blood\u2013brain barrier dysfunction in postoperative delirium and hospital length of stay among older surgery patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Cognitive testing, delirium assessment, and cerebrospinal fluid and blood sampling were prospectively performed before and after non\u2010cardiac, non\u2010neurologic surgery. Blood\u2013brain barrier dysfunction was assessed using the cerebrospinal fluid\u2010to\u2010plasma albumin ratio (CPAR).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 207 patients (median age\u2009=\u200968\u2009years, 45% female) with complete CPAR and delirium data, 26 (12.6%) developed postoperative delirium. Overall, CPAR increased from before to 24\u2009hours after surgery (median change\u2009=\u20090.28, interquartile range [IQR] = \u22120.48 to 1.24, Wilcoxon\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001). Preoperative to 24\u2009hours postoperative change in CPAR was greater among patients who developed delirium versus those who did not (median [IQR] =\u20091.31 [0.004 to 2.34] vs 0.19 [\u22120.55 to 1.08],\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.003). In a multivariable model adjusting for age, baseline cognition, and surgery type, preoperative to 24\u2009hours postoperative change in CPAR was independently associated with delirium occurrence (per CPAR increase of 1, odds ratio\u2009=\u20091.30, 95% confidence interval [CI] =\u20091.03\u20131.63,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.026) and increased hospital length of stay (incidence rate ratio\u2009=\u20091.15, 95% CI\u2009=\u20091.09\u20131.22,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interpretation<\/jats:title>\n                    <jats:p>Postoperative increases in blood\u2013brain barrier permeability are independently associated with increased delirium rates and postoperative hospital length of stay. Although these findings do not establish causality, studies are warranted to determine whether interventions to reduce postoperative blood\u2013brain barrier dysfunction would reduce postoperative delirium rates and hospital length of stay. ANN NEUROL 2023;94:1024\u20131035<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ana.26771","type":"journal-article","created":{"date-parts":[[2023,8,24]],"date-time":"2023-08-24T10:43:57Z","timestamp":1692873837000},"page":"1024-1035","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":72,"title":["Role of Blood\u2013Brain Barrier Dysfunction in Delirium following Non\u2010cardiac Surgery in Older Adults"],"prefix":"10.1002","volume":"94","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3906-6421","authenticated-orcid":false,"given":"Michael J.","family":"Devinney","sequence":"first","affiliation":[{"name":"Department of Anesthesiology Duke University School of Medicine  Durham NC USA"},{"name":"Duke Center for the Study of Aging and Human Development Duke University Medical Center  Durham NC USA"},{"name":"Duke\/University of North Carolina Alzheimer's Disease Research Center Duke University  Durham NC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan K.","family":"Wong","sequence":"additional","affiliation":[{"name":"School of Medicine Duke University  Durham NC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary Cooter","family":"Wright","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Duke University School of Medicine  Durham NC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward R.","family":"Marcantonio","sequence":"additional","affiliation":[{"name":"Division of General Medicine and Gerontology, Department of Medicine Beth Israel Deaconess Medical Center, Harvard Medical School  Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niccol\u00f2","family":"Terrando","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Duke University School of Medicine  Durham NC USA"},{"name":"Department of Cell Biology Duke University School of Medicine  Durham NC USA"},{"name":"Department of Immunology Duke University School of Medicine  Durham NC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8573-7073","authenticated-orcid":false,"given":"Jeffrey N.","family":"Browndyke","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences Duke University School of Medicine  Durham NC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heather E.","family":"Whitson","sequence":"additional","affiliation":[{"name":"Duke Center for the Study of Aging and Human Development Duke University Medical Center  Durham NC USA"},{"name":"Duke\/University of North Carolina Alzheimer's Disease Research Center Duke University  Durham NC USA"},{"name":"Division of Geriatric Medicine, Department of Medicine Duke University School of Medicine  Durham NC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harvey J.","family":"Cohen","sequence":"additional","affiliation":[{"name":"Duke Center for the Study of Aging and Human Development Duke University Medical Center  Durham NC USA"},{"name":"Duke\/University of North Carolina Alzheimer's Disease Research Center Duke University  Durham NC USA"},{"name":"Division of Geriatric Medicine, Department of Medicine Duke University School of Medicine  Durham NC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea G.","family":"Nackley","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Duke University School of Medicine  Durham NC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marguerita E.","family":"Klein","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Duke University School of Medicine  Durham NC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E. 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