Predictive Value of Preoperative Serum pNF-H,AChE,and sTNFR1 Levels for Postoperative Delirium Following Laparoscopic Surgery in Gynecological Tumor Patients
LI Dechao
LIANG Huaipan
GAO Tiemei
MIAO Xiang
LI Lili
PENG Bing
Abstract：Objective To analyze the predictive value of preoperative serum phosphorylated neurofilament heavy chain(pNF-H),acetylcholinesterase(AChE),and soluble tumor necrosis factor receptor 1(sTNFR1)for postoperative delirium in gynecological tumor patients undergoing laparoscopic surgery.Methods A total of 120 gynecological tumor patients admitted to Nanjing Pukou People's Hospital from May 2023 to May 2025 were selected as study subjects.Based on the occurrence of postoperative delirium,they were divided into a delirium group(31 cases)and a non-delirium group(89 cases).Preoperative serum levels of pNF-H,AChE,and sTNFR1 were measured using enzyme-linked immunosorbent assay.Multivariate logistic regression was used to analyze influencing factors for postoperative delirium after laparoscopic surgery in gynecological tumor patients.The relative risks of postoperative delirium were compared among patients with different levels of pNF-H,AChE,and sTNFR1.Receiver operating characteristic(ROC)curves were employed to evaluate the predictive value of preoperative pNF-H,AChE,and sTNFR1 levels for postoperative delirium in gynecological tumor patients after laparoscopic surgery.Results Compared with the non-delirium group,the delirium group showed higher preoperative serum levels of pNF-H,AChE,and sTNFR1(P<0.05),longer postoperative waking time(P<0.05),and lower Mini-Mental State Examination(MMSE)scores on the third day after surgery(P<0.05).Preoperative serum pNF-H,AChE,and sTNFR1 levels as well as postoperative waking time were all influencing factors for postoperative delirium in gynecological tumor patients undergoing laparoscopic surgery(P<0.05).The relative risks of postoperative delirium in patients with serum pNF-H≥702.00 pg/mL,AChE≥32.92 mU/mL,and sTNFR1≥235.37 pg/mL were 2.010,2.781,and 2.019 times higher,respectively,than those in patients with pNF-H<702.00 pg/mL,AChE<32.92 mU/mL,and sTNFR1<235.37 pg/mL(χ2=4.853,9.126,5.267,P<0.05).ROC curve analysis showed that the AUC values of preoperative serum pNF-H,AChE,and sTNFR1 levels for predicting postoperative delirium were 0.855(95%CI:0.783-0.926),0.843(95%CI:0.769-0.916),and 0.833(95%CI:0.755-0.911),respectively.The combined AUC of the three markers for predicting postoperative delirium was 0.958(95%CI:0.924-0.991),which was superior to the AUC values of pNF-H(Z=2.587,P<0.05),AChE(Z=2.824,P<0.05),and sTNFR1(Z=2.749,P<0.05)alone.Conclusion Gynecological tumor patients who developed delirium after laparoscopic surgery had elevated preoperative serum levels of pNF-H,AChE,and sTNFR1.The combination of these three biomarkers showed high predictive value for postoperative delirium.
Keywords：gynecological tumorlaparoscopyphosphorylated neurofilament heavy chainacetylcholinesterasesoluble tumor necrosis factor receptor 1postoperative deliriumprediction
Publication Date：2025-10-20
Online Publishing Date：2025-10-28(First online date of this platform, not the publication date of the document)
Pages：5( 1-5 )