The Relationship between Longer Leukocyte Telomeres and dNCR in Non-Cardiac Surgery Patients: A Retrospective Analysis

Abstract Background: Postsurgical cognitive decline is a common complaint among older adults. While the mechanisms that contribute to this outcome are incompletely understood, leukocyte telomere length (LTL) can be measured as a form of a biological clock associated with individual lifespan. As such, LTL offers potential utility as an aging-associated biomarker that can be used to evaluate delayed neurocognitive recovery (dNCR) and related conditions. Methods : For this study, 196 adults over 60 years of age scheduled to undergo major non-cardiac surgical procedures underwent neuropsychological testing pre-one day and the post-one week following surgery. The finding of dNCR was based on a measured Z-score ≤ -1.96 on two or more separate tests. The frequency of dNCR was presented as the primary outcome of the study. Secondly, we evaluated the association between dNCR and preoperative LTL. Results : Overall, 20.4% [40/196; 95% confidence interval (CI), 14.7-26.1%] of patients exhibited dNCR at 1-week post-surgery. Longer LTL was identified as a predictor for the onset of early cognitive impairment resulting in post-operative cognitive decline [odds ratio (OR), 14.82; 95% CI, 4.01-54.84; P < 0.001], following adjustment of age (OR, 12.33; 95% CI, 3.29-46.24; P< 0.001). The dNCR incidence based on LTL values of these patients, the area under the receiver operating characteristic (ROC) curve was 0.79 (95% CI, 0.722-0.859; P <0.001). At an optimal cut-off value of 0.959, LTL values offered respective specificity and sensitivity values of 64.7% and 87.5%. Conclusions: The incidence of dNCR was substantially correlated with the longer LTL. This biomarker may help identify patients at higher risk and clarify the etiology of dNCR.