{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T11:08:26Z","timestamp":1793531306448,"version":"4.5.0"},"reference-count":51,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2026,1,25]],"date-time":"2026-01-25T00:00:00Z","timestamp":1769299200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["P01AG031720"],"award-info":[{"award-number":["P01AG031720"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Delirium is a common complication of hospitalization with poor outcomes, but its underlying pathophysiology is poorly understood. We investigated the association of preoperative glial fibrillary acidic protein (GFAP), a biomarker of reactive astrocytosis, with delirium incidence and severity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Data were obtained from the ongoing prospective successful aging after elective surgery (SAGES) study. GFAP was measured in preoperative plasma (n\u2009=\u2009529). Postoperative delirium incidence and severity were measured using the confusion assessment method (CAM) and CAM-S (0-19, 19 worst), respectively. A multivariable generalized linear model (GLM) with log link and binary or Poisson error distribution was used to estimate the relative risk of delirium by GFAP quartile scale, and GLM with identity link was used to examine the association of preoperative GFAP and delirium severity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Overall mean preoperative GFAP value was 289.6\u2009\u00b1\u2009153.3 pg\/mL; mean value by quartile (Q) was 148.1\u2009\u00b1\u200928.6 pg\/mL for Q1, 220.5\u2009\u00b1\u200919.8 pg\/mL for Q2, 298.2\u2009\u00b1\u200928.4 pg\/mL for Q3, and 503.4\u2009\u00b1\u2009128.3 pg\/mL for Q4. Delirium incidence by GFAP level was 16% in Q1, 24% in Q2, 25% in Q3, and 28% in Q4 (Cochran trend test P-value\u2009=\u20090.031; adjusted P-value\u2009=\u20090.205). Higher GFAP levels (fourth vs. first quartile) were associated with greater risk of incident delirium (adjusted relative risk 1.70, 95% confidence interval [CI]: 1.01-2.86) and greater delirium severity (adjusted mean difference 0.86, 95% CI: 0.004-1.71).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>High preoperative plasma GFAP was associated with increased delirium incidence and severity, suggesting GFAP may serve as a risk marker for delirium. Brain vulnerability in the setting of astrocytosis may contribute to delirium pathophysiology.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/gerona\/glag017","type":"journal-article","created":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T12:58:55Z","timestamp":1769086735000},"source":"Crossref","is-referenced-by-count":3,"title":["Preoperative plasma glial fibrillary acidic protein and postoperative delirium in older adults"],"prefix":"10.1093","volume":"81","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1250-1043","authenticated-orcid":false,"given":"Julianna","family":"Liu","sequence":"first","affiliation":[{"name":"University of Rochester School of Medicine and Dentistry , Rochester, New York,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven E","family":"Arnold","sequence":"additional","affiliation":[{"name":"MassGeneral Institute for Neurodegenerative Disease, Department of Neurology, Massachusetts General Hospital, Harvard Medical School , Boston, Massachusetts,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pia","family":"Kivis\u00e4kk","sequence":"additional","affiliation":[{"name":"MassGeneral Institute for Neurodegenerative Disease, Department of Neurology, Massachusetts General Hospital, Harvard Medical School , Boston, Massachusetts,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hadia","family":"Fatima","sequence":"additional","affiliation":[{"name":"MassGeneral Institute for Neurodegenerative Disease, Department of Neurology, Massachusetts General Hospital, Harvard Medical School , Boston, Massachusetts,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva M","family":"Schmitt","sequence":"additional","affiliation":[{"name":"Aging Brain Center, Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School , Boston, Massachusetts,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2911-4250","authenticated-orcid":false,"given":"Edward R","family":"Marcantonio","sequence":"additional","affiliation":[{"name":"Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School , Boston, Massachusetts,","place":["United States"]},{"name":"Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School , Boston, Massachusetts,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alvaro","family":"Pascual-Leone","sequence":"additional","affiliation":[{"name":"Hinda and Arthur Marcus Institute for Aging Research and Deanna and Sidney Wolk Center for Memory Health, Hebrew SeniorLife, Harvard Medical School , Boston, Massachusetts,","place":["United States"]},{"name":"Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School , Boston, Massachusetts,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4531-1967","authenticated-orcid":false,"given":"Mouhsin M","family":"Shafi","sequence":"additional","affiliation":[{"name":"Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School , Boston, Massachusetts,","place":["United States"]},{"name":"Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School , Boston, Massachusetts,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1876-639X","authenticated-orcid":false,"given":"Michele","family":"Cavallari","sequence":"additional","affiliation":[{"name":"Aging Brain Center, Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School , Boston, Massachusetts,","place":["United States"]},{"name":"Department of Radiology, Center for Neurological Imaging, Brigham and Women\u2019s Hospital, Harvard Medical School , Boston, Massachusetts,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1049-218X","authenticated-orcid":false,"given":"Richard N","family":"Jones","sequence":"additional","affiliation":[{"name":"Departments of Psychiatry and Human Behavior and Neurology, Warren Alpert Medical School, Brown University , Providence, Rhode Island,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Long H","family":"Ngo","sequence":"additional","affiliation":[{"name":"Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School , Boston, Massachusetts,","place":["United States"]},{"name":"Department of Biostatistics, Harvard T.H. 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