Serum S100A6, ICAM-1, and S100B and neurocognitive outcomes after pediatric tonsillectomy and adenoidectomy

Abstract

To investigate the relationship between serum levels of S100 calcium-binding protein A6 (S100A6), intercellular adhesion molecule-1 (ICAM-1), and S100 calcium-binding protein B (S100B) and the development of postoperative delirium (POD) and postoperative cognitive dysfunction (POCD) in children undergoing tonsillectomy and adenoidectomy under sevoflurane anesthesia. A total of 300 children scheduled for tonsillectomy and adenoidectomy under sevoflurane anesthesia were prospectively enrolled. The Cornell Assessment of Pediatric Delirium (CAPD) was used to assess POD, and the Wechsler Preschool and Primary Scale of Intelligence or the Wechsler Intelligence Scale for Children-Revised was used to evaluate POCD. Serum levels of S100A6, ICAM-1, and S100B were measured 24 h post-surgery. The marker levels were compared between the POD and non-POD groups, and between the POCD and non-POCD groups. Correlations between the markers and CAPD scores/cognitive function z-scores were analyzed. Restricted cubic spline models were used to assess dose-response relationships, and multivariate logistic regression models were constructed to evaluate the independent associations and combined discriminatory power of the three biomarkers. Among the 300 children, 62 (20.7%) developed POD and 43 (14.3%) developed POCD. Serum levels of S100B, ICAM-1, and S100A6 at 24 h postoperatively were significantly higher in the POD group than in the non-POD group (all P < 0.001), and significant elevations were also observed in the POCD group (all P < 0.05). All three biomarkers showed positive correlations with CAPD scores and cognitive function z-scores (all P < 0.001); S100B showed the strongest correlation ( r = 0.55 and 0.48, respectively). Restricted cubic spline analysis revealed a positive dose-response relationship between the levels of all three markers and the risk of both POD and POCD (all P < 0.05). After adjusting for age and anesthesia duration, multivariate logistic regression confirmed that each biomarker was independently associated with both POD and POCD (all P ≤ 0.001). The combined model of the three biomarkers showed superior discriminatory power (POD: area under the receiver operating characteristic curve [AUC] = 0.872; POCD: AUC = 0.841) compared to any single marker. Serum levels of S100A6, ICAM-1, and S100B are independently associated with POD and POCD following pediatric tonsillectomy and adenoidectomy under sevoflurane anesthesia. Combined detection improves the discriminatory ability for these associations, suggesting that postoperative neurocognitive complications may be related to multiple biological processes involving brain injury-related signaling, endothelial activation, and inflammatory responses.