Preoperative Plasma p-tau231，p-tau181 and p-tau217 are associated with Postoperative Delirium: a prospective study

Abstract Background The pathophysiology of delirium remains incompletely understood. The relationship between preoperative plasma concentrations of p-tau181, p-tau231, p-tau217, and T-tau proteins and postoperative delirium needs further validation. We aimed to verify whether these markers can identify and predict the occurrence and severity of postoperative delirium. Methods 172 older adults undergoing laparoscopic surgery were selected from a tertiary comprehensive hospital. All patients received intravenous anesthesia. Preoperative plasma concentrations of p-tau181, p-tau231, p-tau217, and T-tau proteins were measured using enzyme-linked immunosorbent assay. The occurrence and severity of postoperative delirium were respectively assessed using the 3D-CAM and DRS-R-98 scales. Results Of 172 patients (mean age: 72±6 years, 34.9% female), 20 (12%) experienced postoperative delirium. Patients who developed postoperative delirium had higher preoperative plasma concentrations of p-tau181, p-tau231, p-tau217, and T-tau than those without. After adjusting for age, ASA, and education, preoperative concentrations of p-tau181 (OR 1.05, 95% CI: 1.03–1.08), p-tau217 (OR 1.02, 95% CI: 1.01–1.04), p-tau231 (OR 1.09, 95% CI: 1.04–1.14), and T-tau (OR 1.01, 95% CI: 1.00–1.02) were independently associated with postoperative delirium(P＜0.001). Preoperative plasma p-tau231 showed the highest diagnostic performance with an AUC of 0.966, surpassing p-tau181 (0.869), p-tau217 (0.775), and T-tau (0.750). P-tau231 also demonstrated the highest sensitivity (0.900) and specificity (0.967) for predicting postoperative delirium, compared to p-tau181, p-tau217, and T-tau. Conclusion Preoperative plasma concentrations of p-tau181, p-tau231, and p-tau217 can effectively predict the occurrence and severity of postoperative delirium in older adult undergoing laparoscopic surgery, with p-tau231 demonstrating higher predictive value.