{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T03:41:40Z","timestamp":1785296500855,"version":"3.55.0"},"reference-count":35,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,4,21]],"date-time":"2025-04-21T00:00:00Z","timestamp":1745193600000},"content-version":"vor","delay-in-days":20,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["81970448"],"award-info":[{"award-number":["81970448"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82371476"],"award-info":[{"award-number":["82371476"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Brain and Behavior"],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Cerebrospinal fluid A\u03b242 has been proposed as a potential indicator for cerebral \u03b2\u2010amyloidosis and may be involved in the pathophysiology of delirium. Whether perioperative plasma A\u03b242 alternation is associated with postoperative delirium risk among elderly patients remains unknown.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was a secondary analysis of a randomized controlled trial evaluating the effects of acupuncture (intervention) compared to standard care (control) on the incidence of delirium in patients undergoing major abdominal surgery. Participants with blood samples collected were included in this cohort study. The exposure variable was the A\u03b242 ratio, calculated with the plasma A\u03b242 level immediately after surgery divided by the preoperative plasma A\u03b242 level. The primary endpoint was the occurrence of delirium within the first 7\u00a0days following surgery or until hospital discharge, whichever happened first, evaluated using either the Confusion Assessment Method or the Confusion Assessment Method\u2010intensive care unit for intubated patients. Delirium severity was a secondary outcome assessed by the Memorial Delirium Assessment Scale. The logistic regression models and a restricted cubic spline were performed to examine the association between the A\u03b242 ratio and delirium incidence, with receiver operating characteristic curve (ROC) analysis for diagnostic power. The mediation effects of the matrix metalloproteinase\u20109 ratio were further explored by causal mediation analysis. The linear regression and generalized linear mixed models assessed the association between the A\u03b242 ratio and delirium severity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 195 patients with blood samples collected were included in the final analysis. Among them, the mean age was 70.2\u00a0\u00b1\u00a04.2\u00a0years; 134 were female (68.7%), and 26 (13.3%) patients experienced postoperative delirium. The plasma A\u03b242 ratio was positively correlated with an increased delirium risk (adjusted odds ratio 3.21, 95% confidence interval 1.71\u20136.05,\n                      <jats:italic>p\u00a0&lt;\u00a0<\/jats:italic>\n                      0.001) and delirium severity, as measured by the highest postoperative Memorial Delirium Assessment Scale score (adjusted\n                      <jats:italic>\u03b2<\/jats:italic>\n                      coefficient 3.04, 95% confidence interval 0.9\u20135.18,\n                      <jats:italic>p\u00a0<\/jats:italic>\n                      =\u00a00.006) in the fully adjusted multivariable analysis models. The restricted cubic spline indicated a linear relationship between the plasma A\u03b242 ratio and delirium incidence (\n                      <jats:italic>p\u00a0<\/jats:italic>\n                      =\u00a00.202). The ROC showed that the area under the curve for the A\u03b242 ratio to predict delirium risk was 0.698 (95% CI, 0.582\u20130.814), with the optimal cut\u2010off point of 0.137. Mediation analyses showed that the A\u03b242 ratio does not mediate postoperative delirium through the matrix metalloproteinase\u20109 ratio (proportion: 1.3%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This cohort study showed that a higher A\u03b242 ratio was associated with an increased delirium risk and severity, and the association was linear. The plasma A\u03b242 ratio might be a mini\u2010invasive biomarker to identify postoperative delirium.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/brb3.70501","type":"journal-article","created":{"date-parts":[[2025,4,22]],"date-time":"2025-04-22T02:09:22Z","timestamp":1745287762000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Association Between Plasma Amyloid\u2010Beta 42 Ratio and Postoperative Delirium in Elderly Patients Undergoing Major Abdominal Surgery: Secondary Analysis of a Randomized Controlled Trial"],"prefix":"10.1002","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5284-3921","authenticated-orcid":false,"given":"Qianqian","family":"Fan","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Perioperative Medicine Xijing Hospital Fourth Military Medical University  Xi'an China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yonghui","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Perioperative Medicine Xijing Hospital Fourth Military Medical University  Xi'an China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhihong","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Perioperative Medicine Xijing Hospital Fourth Military Medical University  Xi'an China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lini","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Perioperative Medicine Xijing Hospital Fourth Military Medical University  Xi'an China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xue","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Perioperative Medicine Xijing Hospital Fourth Military Medical University  Xi'an China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ziyu","family":"Zheng","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Perioperative Medicine Xijing Hospital Fourth Military Medical University  Xi'an China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hailong","family":"Dong","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Perioperative Medicine Xijing Hospital Fourth Military Medical University  Xi'an China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lize","family":"Xiong","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Translational Research Institute of Brain and Brain\u2010Like Intelligence Shanghai Fourth People's Hospital Affiliated to Tongji University School of Medicine  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chong","family":"Lei","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Perioperative Medicine Xijing Hospital Fourth Military Medical University  Xi'an China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,4,21]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00401\u2010022\u201002458\u20109"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1038\/mp.2017.204"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arr.2021.101420"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awz354"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598\u2010019\u201050315\u20109"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2020.09.043"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2022.855296"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1113\/jp280038"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41582\u2010022\u201000698\u20107"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/eja.0000000000001933"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.21554"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/trc2.12004"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra052321"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/s1474\u20104422(09)70299\u20106"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1155\/2021\/9960304"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.3389\/fnagi.2025.1532676"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/aln.0000000000003016"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMcp1605501"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aet420"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1038\/nature25456"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/s1474\u20104422(16)00070\u20103"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2023.01.020"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13019\u2010022\u201001755\u20104"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1002\/psc.2789"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0140\u20106736(15)01124\u20101"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.2010.205757"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12974\u2010023\u201003003\u20105"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2022.01.005"},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.1186\/cc10598"},{"key":"e_1_2_11_31_1","doi-asserted-by":"publisher","DOI":"10.1002\/ana.20050"},{"key":"e_1_2_11_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijsu.2014.07.013"},{"key":"e_1_2_11_33_1","doi-asserted-by":"publisher","DOI":"10.3233\/jad\u2010190714"},{"key":"e_1_2_11_34_1","doi-asserted-by":"publisher","DOI":"10.3233\/jad\u2010180140"},{"key":"e_1_2_11_35_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aex103"},{"key":"e_1_2_11_36_1","doi-asserted-by":"publisher","DOI":"10.1080\/15548627.2021.1886720"}],"container-title":["Brain and Behavior"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/brb3.70501","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,29]],"date-time":"2025-09-29T08:43:32Z","timestamp":1759135412000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/brb3.70501"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4]]},"references-count":35,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025,4]]}},"alternative-id":["10.1002\/brb3.70501"],"URL":"https:\/\/doi.org\/10.1002\/brb3.70501","archive":["Portico"],"relation":{"has-review":[{"id-type":"doi","id":"10.1002\/BRB3.70501\/v2\/decision1","asserted-by":"object"},{"id-type":"doi","id":"10.1002\/BRB3.70501\/v2\/review1","asserted-by":"object"},{"id-type":"doi","id":"10.1002\/BRB3.70501\/v1\/review1","asserted-by":"object"},{"id-type":"doi","id":"10.1002\/BRB3.70501\/v1\/review2","asserted-by":"object"},{"id-type":"doi","id":"10.1002\/BRB3.70501\/v2\/response1","asserted-by":"object"},{"id-type":"doi","id":"10.1002\/BRB3.70501\/v1\/decision1","asserted-by":"object"}]},"ISSN":["2162-3279","2162-3279"],"issn-type":[{"value":"2162-3279","type":"print"},{"value":"2162-3279","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4]]},"assertion":[{"value":"2025-01-23","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-04-04","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-04-21","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70501"}}