S100B level and cognitive dysfunction after robotic-assisted laparoscopic radical prostatectomy procedures: a prospective observational study

Ozturk, Nilgun Kavrut; Kavakli, Ali Sait; Arslan, Ulku; Aykal, Guzin; Savas, Murat

doi:10.1016/j.bjane.2020.06.016

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Revista Brasileira de Anestesiologia

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CLINICAL RESEARCH • Rev. Bras. Anestesiol. 70 (6) • Nov-Dec 2020 • https://doi.org/10.1016/j.bjane.2020.06.016 copy

S100B level and cognitive dysfunction after robotic-assisted laparoscopic radical prostatectomy procedures: a prospective observational study

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background:

The present study investigated the association between Postoperative Cognitive Dysfunction (POCD) and increased serum S100B level after Robotic-Assisted Laparoscopic Radical Prostatectomy (RALRP).

Methods:

The study included 82 consecutive patients who underwent RALRP. Serum S100B levels were determined preoperatively, after anesthesia induction, and at 30 minutes and 24 hours postoperatively. Cognitive function was assessed using neuropsychological testing preoperatively, and at 7 days and 3 months postoperatively.

Results:

Twenty four patients (29%) exhibited POCD 7 days after surgery, and 9 (11%) at 3 months after surgery. Serum S100B levels were significantly increased at postoperative 30 minutes and 24 hours in patients displaying POCD at postoperative 7 days (p = 0.0001 for both) and 3 months (p = 0.001 for both) compared to patients without POCD. Duration of anesthesia was also significantly longer in patients with POCD at 7 days and 3 months after surgery compared with patients without POCD (p = 0.012, p = 0.001, respectively), as was duration of Trendelenburg (p = 0.025, p = 0.002, respectively). Composite Z score in tests performed on day 7 were significantly correlated with duration of Trendelenburg and duration of anesthesia (p = 0.0001 for both).

Conclusions:

S100B increases after RALRP and this increase is associated with POCD development. Duration of Trendelenburg position and anesthesia contribute to the development of POCD.

Trial Registry Number:

Clinicaltrials.gov (N° NCT03018522).

Keywords
S100B protein; Postoperative cognitive dysfunction; Robotic assisted laparoscopic radical prostatectomy

	Study Group (n = 82)	Control Group (n = 20)	p-value
Age, years	62.2 ± 7.8	63.9 ± 5.1	0.365
Body mass index, kg.m^-2	26.1 ± 3.9	25.4 ± 4.6	0.546
Education, years	10 (5-15)	9.8 (5-15)	0.487
Duration of Trendelenburg, min	237 ± 55	-	-
Duration of anesthesia, min	328 ± 62	-	-
Hospital stay, days	6 ± 2	-	-

ASA status
I, n (%)	8 (10)	2 (10)	0.489
II, n (%)	54 (66)	14 (70)	0.517
III, n (%)	20 (27)	4 (20)	0.356

Comorbidity
Arterial hypertension, n (%)	28 (34)	9 (45)	0.125
Diabetes mellitus, n (%)	31 (38)	8 (40)	0.273
COPD, n (%)	7 (8)	2 (10)	0.132
CRF, n (%)	3 (3)	0 (0)	0.223
Smoking	34 (42)	8 (40)	0.316

Baseline test scores
MMSE	28.1 ± 2.1 (27-30)	27.9 ± 2.6 (26-30)	0.276
TMT-a	57.9 ± 11.3 (40-80)	56.1 ± 16.1 (30-88)	0.581
TMT-b	126.1 ± 17.6 (100-161)	123.2 ± 20.1 (82-160)	0.542
RAVLT (delayed recall)	5.3 ± 1.1 (4-8)	5.9 ± 1.9 (2-9)	0.115
DST forward	5.2 ± 0.5 (4-6)	5.9 ± 1.3 (3-8)	0.088
DST backward	3.8 ± 0.6 (3-5)	3 ± 1.1 (1-4)	0.105
GPT dominant	102.1 ± 13.7 (78-131)	105.6 ± 18 (80-140)	0.372
GPT non-dominant	122.1 ± 15.3 (90-150)	122.7 ± 17.3 (99-164)	0.895

	POCD absent (n = 58)	POCD present (n = 24)	p-value
Age, years	60.6 ± 7.6	66 ± 7.2	0.062
Education, years	9.7 ± 3.3	10.7 ± 3.3	0.276
Duration of Trendelenburg, min	211 ± 36	296 ± 54	0.025^a a p < 0.05.
Duration of anesthesia, min	300 ± 37	394 ± 63	0.012^a a p < 0.05.

S100B values
Baseline	0.24 ± 0.07	0.24 ± 0.07	0.967
After induction	0.30 ± 0.10	0.28 ± 0.09	0.473
Postoperative 30 min	1.01 ± 0.28	1.66 ± 0.26	0.0001^a a p < 0.05.
Postoperative 24 hours	0.36 ± 0.14	0.57 ± 0.19	0.001^a a p < 0.05.

Baseline test scores
MMSE	27.4 ± 3.1 (27-30)	27.6 ± 2.2 (26-30)	0.496
TMT-a	58.9 ± 11.2	55.2 ± 11.3	0.246
TMT-b	128 ± 18.9	121.5 ± 13.5	0.195
RAVLT (delayed recall)	5.2 ± 1.1	5.5 ± 1.1	0.434
DST forward	5.2 ± 0.6	5.2 ± 0.5	0.763
DST backward	3.9 ± 0.5	3.7 ± 0.8	0.405
GPT dominant	104.3 ± 13.5	96.7 ± 12.9	0.046
GPT non-dominant	122.5 ± 15.1	121.2 ± 16.2	0.775

Test scores on postoperative day 7
TMT-a	67.6 ± 10.4	106 ± 14.6	0.0001^a a p < 0.05.
TMT-b	133.8 ± 14.2	166.9 ± 17	0.0001^a a p < 0.05.
RAVLT	5.2 ± 0.9	4.5 ± 1.6	0.033^a a p < 0.05.
DST forward	4.3 ± 0.8	3.7 ± 1.2	0.059
DST backward	2.9 ± 0.7	2.6 ± 0.9	0.212
GPT dominant	108 ± 13	122.3 ± 27.4	0.007^a a p < 0.05.
GPT non-dominant	130.4 ± 17.4	155.6 ± 23.5	0.0001^a a p < 0.05.

	POCD absent (n = 73)	POCD present (n = 9)	p-value
Age, years	61.2 ± 7.5	70 ± 5	0.030^a a p < 0.05.
Education. years	9.8 ± 3.3	11.2 ± 2.8	0.303
Duration of Trendelenburg, min	227 ± 52	274 ± 37	0.002^a a p < 0.05.
Duration of anesthesia, min	317 ± 56	410 ± 52	0.001^a a p < 0.05.

S100B values
Baseline	0.24 ± 0.07	0.22 ± 0.06	0.556
After induction	0.30 ± 0.10	0.25 ± 0.08	0.196
Postoperative 30 min	1.12 ± 0.34	1.80 ± 0.36	0.0001^a a p < 0.05.
Postoperative 24 h	0.40 ± 0.16	0.65 ± 0.17	0.001^a a p < 0.05.

Baseline test scores
MMSE	26.9 ± 2.1 (27-30)	27.3 ± 3.1 (26-30)	0.541
TMT-a	57.7 ± 10.8	59.1 ± 15.4	0.761
TMT-b	126.6 ± 17.8	121.8 ± 17.1	0.502
RAVLT (delayed recall)	5.3 ± 1.1	5.4 ± 1.6	0.892
DST forward	5.2 ± 0.6	5.2 ± 0.4	0.837
DST backward	3.8 ± 0.6	4 ± 1	0.632
GPT dominant	103.2 ± 13.7	93.4 ± 11.1	0.075
GPT non-dominant	122.8 ± 15.2	116.7 ± 16.2	0.324

Test scores at postoperative 3 months
TMT-a	66.3 ± 10.7	117.5 ± 13.2	0.0001^a a p < 0.05.
TMT-b	132.1 ± 18.8	167.2 ± 15	0.0001^a a p < 0.05.
RAVLT (delayed recall)	5.3 ± 1	3.5 ± 1.1	0.0001^a
DST forward	4.5 ± 0.8	2.7 ± 0.9	0.0001^a a p < 0.05.
DST backward	3.9 ± 0.7	3.8 ± 0.6	0.859
GPT dominant	107.4 ± 15	120.4 ± 31.7	0.070
GPT non-dominant	125.4 ± 17.5	150.2 ± 29.4	0.002^a a p < 0.05.

	Coefficient (B)	Standard error	B	95% Confidence Interval	p-value
Composite Z score on postoperative day 7
Baseline	4.573	6.538	0.106	-8.520-17.665	0.487
After Trendelenburg	-4.051	4.993	-0.121	-14.049-5.947	0.421
30 min after surgery	5.058	0.763	0.617	3.531-6.586	0.0001
24h after surgery	4.821	1.692	0.267	1.433-8.209	0.006

Composite Z score at postoperative 3 months
Baseline	4.825	6.098	0.156	-7.386-17.035	0.432
After Trendelenburg	-2.723	4.656	-0.114	-12.047-6.60	0.561
Postoperative 30 min	1.631	0.711	0.279	0.206-3.055	0.026
Postoperative 24 h	4.773	1.578	0.37	1.613-7.932	0.004

Sociedade Brasileira de Anestesiologia R. Professor Alfredo Gomes, 36, 22251-080 Botafogo RJ Brasil, Tel: +55 21 2537-8100, Fax: +55 21 2537-8188 - Campinas - SP - Brazil
E-mail: bjan@sbahq.org

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[1] * Corresponding author. E-mail: kavrut@yahoo.com (N. Kavrut Ozturk).