s100β, NSE n GFAP in Living Donor Hepatectomy and Delirium
Condition: Donor Site Complication; Delirium; Uremic Encephalopathy; Neurologic Manifestations
MeSH terms: Delirium; Brain Diseases; Neurologic Manifestations
Study type: Observational

Summary: 
      The post-operative delirium picture is a serious and common complication seen after any major
      surgery, including hepatic resection. Patients who will be planned to undergo donor
      hepatectomy for liver transplantation will be included in the study. Basic clinical and
      demographic information of patients undergoes donor hepatectomy will be recorded before
      surgery. The anatomical parameters such as liver volume, medications performed during the
      surgery, complications, bleeding amounts, fluids given, blood and blood products, vital signs
      during surgery, fluid balance, duration of surgery, recovery length at post-operative period,
      complications after surgery, approaches to complications, analgesics and other medications
      used, hemogram and other biochemical parameters (electrolytes, albumin, liver frontier tests,
      etc.), weight status, vital signs, duration of intensive care, post-operative VAS scores,
      drainage and information such as length of stay, length of hospital stay, the healing time of
      the wound will also be recorded.

      During the hospitalization, the delirium status of the patients will be evaluated with a
      delirium evaluation scale by consultant doctor. Blood will be taken for the measurement of
      S100β, NSE, and GFAP levels one day before donor hepatectomy and following day of
      hepatectomy, 3rd day, and 7th day in the post-operative period. The plasma of the blood taken
      will be separated and stored at -80 0C until working. Laboratory values are taken from the
      patients before the operation will be recorded over the system. The relationship between the
      results obtained and the delirium evaluation scores performed on the days followed will be
      evaluated.

      This study aims to analyze the delirium incidence and post-operative early S100β, NSE, and
      GFAP levels within the first week following the hepatectomy performed in live donors for
      liver transplantation.
    

Detailed description: 
      The postoperative delirium picture is a serious and common complication seen after any major
      surgery, including hepatic resection. Delirium is an acute state of confusion characterized
      by impaired consciousness, reduced ability to focus on attention, changes in cognitive
      functions, a perceptual disturbance development, and an uncomfortable sleep-wake cycle.
      Postoperative delirium has an acute onset and has a fluctuating course. This complication
      results in a long recovery period, a longer stay in the intensive care unit, higher
      complication rates, extra nursing care, and higher costs. Therefore, appropriate methods are
      needed to prevent and treat postoperative delirium.

      The pathophysiology of delirium is thought to be due to many reasons. Examined in titles:
      Changes in the electrolyte and fluid balance, nutritional imbalance (low serum
      protein/albumin level, hypovitaminosis, especially cobalamin deficiencies (B12), folate (B9),
      niacin (B3, pellagra), thiamine, age (> 65) and gender (m> f), hyperthermia and hypothermia,
      major surgical procedures, endocrine disorders, drug use, anemia, anoxia, hypoxia and low
      perfusion/oxygenation states, postoperative pain and painkiller medication, end-organ
      failure, social isolation, decreased intellectual stimulation (long-term intensive care
      therapy), sleep disorders and changes in the circadian rhythm, metabolic disorders (acidosis,
      alkalosis, hyperammonemia, hypersensitivity reactions, glucose, and acid-base disorders,
      limitations, and inactivity. Cases are exposed to these predisposing causes.

      Postoperative delirium is a type of delirium that is exposed to surgical procedure and
      anesthesia, usually seen between the 1st and 3rd days after surgery. Postoperative delirium
      can be seen at rates ranging from 9 to 87% depending on the age of the patient and the type
      of surgery. Although its etiology is not yet understood, it is probably thought to be
      multifactorial.

      S100β is secreted by astrocytes in brain damage. S100β rises while brain damage starts, so it
      can be used in the diagnosis of early brain damage. Neuron-specific enolase (NSE) acts as an
      intracytoplasmic enzyme, and serum levels are increased in neuron damage. The glial fibrillar
      acidic protein (GFAP) is the intermediate filament cytoskeleton protein in astrocytes. It
      originates from the same root structure as S100β. After hepatectomy, the donor candidates are
      exposed to physiological changes that include the central nervous system due to surgical
      stress as well as the functional change of the remaining liver tissue. Determining the
      increase in serum level of biomarkers specific to the central nervous system mentioned before
      the development of cognitive disorders such as delirium may prevent the complications that
      may arise during the postoperative period. It also helps to provide treatment in the
      postoperative period as well as evaluation.

      The aim of this study is to analyze the delirium incidence and postoperative early S100β,
      NSE, and GFAP levels within the first week following the hepatectomy performed in living
      donors for liver transplantation.
    

Intervention name(s): Living Donor Hepatectomy
Intervention type(s): Procedure
Intervention description(s): On living donor hepatectomy (preoperative), the first following day of surgery, 3rd day, and 7th day, blood will be taken for the measurement of S100β, NSE, and GFAP levels in the postoperative period. The plasma of the blood taken will be separated and stored at -800C. Values will be measured by the ELISA method. During the hospitalization, the delirium status of the patients will be evaluated with the delirium evaluation scale (Delirium Rating Scale-Revised - 98 Turkish version). Functional and cognitive information and other results will be collected at each follow-up point.
Observational model: Case-Only
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        Patients' demographic data (age, gender, weight, height), accompanying diseases, ASA
        classification, main etiology, preoperative serums taken in the preoperative period; serum
        sodium, potassium, ammonium, total bilirubin, ALT, AST, albumin, alkaline phosphatase, INR,
        creatinine, and BUN shall be recorded accordingly. In addition, routinely taken
        anesthetics, duration of the operation, duration of anesthesia, duration before the
        reperfusion, duration of postperfusion, first measured central venous pressure, volume
        replacement therapy, blood component transfusion, the total fluid amount given during the
        operation, corticosteroids and immunosuppressive drugs given during the operation shall be
        recorded. Besides, the cognitive functions of the patients and blood samples for mentioned
        values will be evaluated in the preoperative and postoperative periods.
      
Biospecimen description: 
      s100β, neuron specific enolase and glial fibrillary acidic
    
Keywords: donor living hepatectomy; s100β; neuron specific enolase; glial fibrillary acidic protein; delirium