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Biomarkers associated with delirium in critically ill patients and their relation with long-term subjective cognitive dysfunction; indications for different pathways governing delirium in inflamed and noninflamed patients

Record type: Article

Introduction: Delirium occurs frequently in critically ill patients and is associated with disease severity and infection. Although several pathways for delirium have been described, biomarkers associated with delirium in intensive care unit (ICU) patients is not well studied. We examined plasma biomarkers in delirious and nondelirious patients and the role of these biomarkers on long-term cognitive function.

Methods: In an exploratory observational study, we included 100 ICU patients with or without delirium and with ("inflamed”) and without ("noninflamed”) infection/systemic inflammatory response syndrome (SIRS). Delirium was diagnosed by using the confusion-assessment method-ICU (CAM-ICU). Within 24 hours after the onset of delirium, blood was obtained for biomarker analysis. No differences in patient characteristics were found between delirious
and nondelirious patients. To determine associations between biomarkers and delirium, univariate and multivariate
logistic regression analyses were performed. Eighteen months after ICU discharge, a cognitive-failure questionnaire was distributed to the ICU survivors.

Results: In total, 50 delirious and 50 nondelirious patients were included. We found that IL-8, MCP-1, procalcitonin (PCT), cortisol, and S100-b were significantly associated with delirium in inflamed patients (n = 46). In the noninflamed group of patients (n = 54), IL-8, IL-1ra, IL-10 ratio Ab1-42/40, and ratio AbN-42/40 were significantly associated with delirium. In multivariate regression analysis, IL-8 was independently associated (odds ratio, 9.0; 95% confidence interval (CI), 1.8 to 44.0) with delirium in inflamed patients and IL-10 (OR 2.6; 95% CI 1.1 to 5.9), and Ab1-42/40 (OR, 0.03; 95% CI, 0.002 to 0.50) with delirium in noninflamed patients. Furthermore, levels of several amyloid-b forms, but not human Tau or S100-b, were significantly correlated with self-reported cognitive impairment 18 months after ICU discharge, whereas inflammatory markers were not correlated to impaired longterm cognitive function.

Conclusions: In inflamed patients, the proinflammatory cytokine IL-8 was associated with delirium, whereas in noninflamed patients, antiinflammatory cytokine IL-10 and Ab1-42/40 were associated with delirium. This suggests that the underlying mechanism governing the development of delirium in inflamed patients differs from that in noninflamed patients. Finally, elevated levels of amyloid-b correlated with long-term subjective cognitive-impairment delirium may represent the first sign of a (subclinical) dementia process. Future studies must confirm these results.

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Citation

Van den Boogaard, Mark, Kox, Matthijs, Quinn, Kieran L., van Achterberg, Theo, van der Hoeven, Johannes G., Schoonhoven, Lisette and Pickkers, Peter (2011) Biomarkers associated with delirium in critically ill patients and their relation with long-term subjective cognitive dysfunction; indications for different pathways governing delirium in inflamed and noninflamed patients Critical Care, 15, R297-[9pp]. (doi:10.1186/cc10598). (PMID:22206727).

More information

Published date: December 2011
Organisations: Faculty of Health Sciences

Identifiers

Local EPrints ID: 339213
URI: http://eprints.soton.ac.uk/id/eprint/339213
ISSN: 1364-8535
PURE UUID: 5a0a1571-0250-44fb-bf87-6d958de728aa
ORCID for Lisette Schoonhoven: ORCID iD orcid.org/0000-0002-7129-3766

Catalogue record

Date deposited: 25 May 2012 10:17
Last modified: 18 Jul 2017 05:54

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Contributors

Author: Mark Van den Boogaard
Author: Matthijs Kox
Author: Kieran L. Quinn
Author: Theo van Achterberg
Author: Johannes G. van der Hoeven
Author: Peter Pickkers

University divisions


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