Association between preoperative isopentenyl pyrophosphate and emergence delirium in patients undergoing kidney transplantation.

BACKGROUND AND AIMS: Emergence delirium (ED) is common after general anesthesia, but preoperative metabolic risk factors are not well defined. This study investigated the association between preoperative serum metabolites and ED in kidney transplant recipients (KTRs).

METHODS

Adult KTRs treated between 2023 and 2024 were retrospectively analyzed. ED was defined as a Richmond Agitation-Sedation Scale score of +1 to +4 in the post-anesthesia care unit (PACU). Preoperative serum metabolites were quantified using targeted metabolomics. Metabolites were screened using univariable logistic regression, selected using least absolute shrinkage and selection operator (LASSO) regression, and evaluated using multivariable logistic regression models. Dose-response relationships were assessed across quartiles of selected metabolites.

RESULTS

Among 107 patients, 28 (26 %) developed ED. Six metabolites were retained by LASSO. Higher preoperative isopentenyl pyrophosphate (IPP) levels were independently associated with ED after adjustment for perioperative covariates (adjusted OR 3.16, 95 % CI 1.16-6.40; P = 0.002). ED risk increased progressively across IPP quartiles (P for trend = 0.007).

CONCLUSION

Elevated preoperative serum IPP levels were associated with an increased risk of ED in KTRs. Further studies are required to confirm these findings.

TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR2500097624 (https://www.chictr.org.cn/).