Plasma biomarkers of inflammation, coagulation, and brain injury as predictors of delirium duration in older hospitalized patients


Autoři: J. Brennan McNeil aff001;  Christopher G. Hughes aff002;  Timothy Girard aff002;  Lorraine B. Ware aff001;  E. Wesley Ely aff001;  Rameela Chandrasekhar aff002;  Jin H. Han aff002
Působiště autorů: Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America aff001;  The Critical Illness, Brain Dysfunction and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America aff002;  Division of Anesthesiology Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America aff003;  Clinical Research, Investigation, and Systems Modeling of Acute illness (CRISMA) Center in the Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America aff004;  Veteran Affairs Geriatric Research, Education, and Clinical Center (GRECC), Nashville, Tennessee, United States of America aff005;  Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America aff006;  Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America aff007
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article
doi: 10.1371/journal.pone.0226412

Souhrn

Background

Delirium's pathophysiology is poorly understood. We sought to determine if plasma biomarkers of inflammation, coagulation, endothelial activation, and blood brain barrier (BBB) injury were associated with emergency department (ED) delirium duration.

Methods

We enrolled hospitalized patients who were 65 years or older from the ED. Plasma biomarkers of inflammation (interleukin-6 [IL-6], IL-8, soluble tumor necrosis factor receptor I [sTNFRI]), coagulation (Protein C), endothelial activation (plasminogen activating inhibitor-1 [PAI-1]), and BBB injury (S100B) at were measured using blood obtained at enrollment. The dependent variable was ED delirium duration which was determined by the Brief Confusion Assessment Method assessed in the ED and hospitalization. Proportional odds logistic regression analyses were performed adjusted for relevant confounders and allowing for interaction by baseline dementia status.

Results

A total of 156 patients were enrolled. IL-6 (POR = 1.59, 95%CI: 1.09–2.32) and PAI-1 (POR = 2.96, 95%CI: 1.48 to 6.85) were independently associated with more prominent ED delirium duration in subjects without dementia only. No significant associations between IL-8, Protein C, sTNRFI, and S100B and ED delirium duration were observed.

Conclusions

Plasma Biomarkers of systemic inflammation and endothelial activation are associated with ED delirium duration in older ED patients without dementia.

Klíčová slova:

Biomarkers – Blood plasma – Brain damage – Central nervous system – Critical care and emergency medicine – Dementia – Inflammation – Pathogenesis


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