{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T05:03:50Z","timestamp":1782968630427,"version":"3.54.5"},"reference-count":43,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2024,3,4]],"date-time":"2024-03-04T00:00:00Z","timestamp":1709510400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["81901842"],"award-info":[{"award-number":["81901842"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004735","name":"Natural Science Foundation of Hunan Province","doi-asserted-by":"publisher","award":["2021JJ40936"],"award-info":[{"award-number":["2021JJ40936"]}],"id":[{"id":"10.13039\/501100004735","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004241","name":"China Primary Health Care Foundation","doi-asserted-by":"publisher","award":["YLGX\u2010WS\u20102020003"],"award-info":[{"award-number":["YLGX\u2010WS\u20102020003"]}],"id":[{"id":"10.13039\/501100004241","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Geriatrics Gerontology Int"],"published-print":{"date-parts":[[2024,4]]},"abstract":"<jats:sec><jats:title>Aim<\/jats:title><jats:p>While insulin sensitivity plays an important role in maintaining glucose metabolic homeostasis and cognitive function, its impact on postoperative delirium (POD) remains unclear. This study aimed to investigate the association between POD and indicators of insulin sensitivity, including insulin resistance and osteocalcin.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A total of 120 elderly patients undergoing joint replacement were recruited and divided into delirium and non\u2010delirium groups. Plasma and cerebrospinal fluid (CSF) samples were collected for the analysis of biomarkers, including insulin, uncarboxylated osteocalcin (ucOC), total osteocalcin (tOC), and glucose. Insulin resistance was assessed through the homeostatic model assessment of insulin resistance (HOMA\u2010IR).<\/jats:p><\/jats:sec><jats:sec><jats:title>Main results<\/jats:title><jats:p>Out of the total, 28 patients (23.3%) experienced POD within 5\u2009days after surgery. Patients with delirium exhibited higher levels of preoperative HOMA\u2010IR and ucOC in CSF and plasma, and of tOC in CSF (<jats:italic>P<\/jats:italic>\u2009=\u20090.028, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001, <jats:italic>P<\/jats:italic>\u2009=\u20090.005, <jats:italic>P<\/jats:italic>\u2009=\u20090.019). After adjusting for variables, including age, Mini\u2010Mental State Examination score, surgical site and preoperative fracture, only preoperative ucOC in CSF and HOMA\u2010IR were significantly linked to the incidence of delirium (OR\u2009=\u20095.940, <jats:italic>P<\/jats:italic>\u2009=\u20090.008; OR\u2009=\u20091.208, <jats:italic>P<\/jats:italic>\u2009=\u20090.046, respectively), both of which also correlated with the severity of delirium (<jats:italic>P<\/jats:italic>\u2009=\u20090.007, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). Receiver operating curve analysis indicated that preoperative HOMA\u2010IR and ucOC in CSF might partly predict POD (area under the curve [AUC]\u2009=\u20090.697, 95% confidence interval [CI]\u2009=\u20090.501\u20130.775, AUC\u2009=\u20090.745, 95% CI\u2009=\u20090.659\u20130.860).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>We observed that preoperative elevated HOMA\u2010IR and ucOC in CSF were associated with the incidence and severity of POD. While these preliminary results need confirmation, they suggest a potential involvement of insulin resistance and osteocalcin in the pathological mechanism of POD. <jats:bold>Geriatr Gerontol Int 2024; 24: 421\u2013429<\/jats:bold>.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ggi.14848","type":"journal-article","created":{"date-parts":[[2024,3,5]],"date-time":"2024-03-05T02:54:06Z","timestamp":1709607246000},"page":"421-429","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Insulin resistance and osteocalcin associate with the incidence and severity of postoperative delirium in elderly patients undergoing joint replacement"],"prefix":"10.1111","volume":"24","author":[{"given":"Yang","family":"Mi","sequence":"first","affiliation":[{"name":"Department of Anesthesiology The Third Xiangya Hospital of Central South University  Changsha 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