Perioperative medicine & outcomes
Association of postoperative elevation of biomarkers of neural injury in blood with postoperative neurocognitive disorders in adults receiving general anaesthesia: a systematic review
Authors' conclusion
The significance of postoperative increases in plasma NfL and GFAP remains uncertain. Low-certainty evidence supports an association between an increase in NfL and POD, with very low certainty of evidence for an association between an increase in GFAP and POD, and either biomarker and POCD.
Study context
- Population
- Patients older than 60 yr undergoing surgery under GA
- Participants
- 1,212 participants · 12 studies
- Comparison
- Postoperative elevation of neurofilament light (NfL) and glial fibrillary acidic protein (GFAP) vs postoperative cognitive disorder (POCD) and postoperative delirium (POD)
- Outcome
- Association between perioperative biomarker (NfL, GFAP) changes and POCD and POD
Methodological detailseffect direction plots, GRADE approach, Quality in Prognosis Studies tool, Searched MEDLINE, EMBASE, Cochrane Library, Scopus, Web of Science and CINAHL, 1990 to May 2025
- Effect direction plots
- GRADE approach
- Quality in Prognosis Studies tool
- Searched MEDLINE, EMBASE, Cochrane Library, Scopus, Web of Science and CINAHL, 1990 to May 2025
Pooled result
As reported in the abstract
- Most studies of NfL reported a postoperative increase
- NfL change and POCD (2 studies) and GFAP change and POCD (3 studies): all high risk of bias, inconsistent findings
- Postoperative NfL increase associated with POD in 4 of 6 studies; substantial variability in populations, confounder adjustment and statistical methods
- No consistent association between GFAP increase and POD
- Low-certainty evidence for NfL and POD; very low certainty for GFAP and POD and for either biomarker and POCD
Original publication
Association of postoperative elevation of biomarkers of neural injury in blood with postoperative neurocognitive disorders in adults receiving general anaesthesia: a systematic review. Br J Anaesth. Published 12 May 2026. doi:10.
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