Muhammad Umar Sajjad1, Kaj Blennow2,3, Anne Brita Knapskog4, Ane-Victoria Idland1,5, Farrukh Abbas Chaudhry1,6, Torgeir Bruun Wyller5, Henrik Zetterberg2,3,7,8, Leiv Otto Watne1,5. 1. Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway. 2. Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden. 3. Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden. 4. Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway. 5. Department of Geriatric Medicine, Oslo Delirium Research Group, Oslo University Hospital, Oslo, Norway. 6. Department of Plastic and Reconstructive Surgery, Oslo University Hospital, Oslo, Norway. 7. Department of Neurodegenerative Disease, UCL Institute of Neurology, London, United Kingdom. 8. UK Dementia Research Institute at UCL, London, United Kingdom.
Abstract
BACKGROUND: Delirium is a common and serious complication in geriatric patients. The pathophysiology of delirium is not known. OBJECTIVE: The objective of the current study was to test the hypothesis that cerebrospinal fluid (CSF) levels of inflammatory markers at the time of spinal anesthesia for hip surgery are associated with delirium. METHODS: In total 133 hip fracture patients and 125 cognitively healthy controls undergoing elective surgery, together with 73 Alzheimer's disease (AD) dementia patients, were recruited at Oslo University Hospital and Diakonhjemmet Hospital, Oslo, Norway. Delirium was evaluated daily in hip fracture patients by the Confusion Assessment Method (CAM). Depression was evaluated by Cornell Scale for Depression in Dementia (CSDD). Tumor necrosis factor alpha (TNF-α), interleukin-1beta (IL-1β), and interleukin-8 (IL-8) levels were measured in CSF using a Mesoscale Discovery (MSD) immunoassay. RESULTS: Hip fracture patients had significantly higher IL-8 levels (p < 0.001) compared to cognitively healthy controls or patients with stable AD dementia. Furthermore, preoperative IL-8 levels were significantly higher (p = 0.013) in hip fracture patients who developed delirium (incident delirium) after surgery as compared to patients with no delirium. However, subgroup analyses showed that IL-8 levels were only significantly higher in delirium patients without dementia (p = 0.006). In contrast, depression subgroup analysis showed that IL-8 concentration was significantly higher (p = 0.002) in delirium patients with depression. Both TNF-α and IL-1β were undetected in most patients. CONCLUSIONS: Our study suggests that IL-8 levels are associated with delirium onset and that underlying depression or dementia influences IL-8 levels.
BACKGROUND:Delirium is a common and serious complication in geriatric patients. The pathophysiology of delirium is not known. OBJECTIVE: The objective of the current study was to test the hypothesis that cerebrospinal fluid (CSF) levels of inflammatory markers at the time of spinal anesthesia for hip surgery are associated with delirium. METHODS: In total 133 hip fracturepatients and 125 cognitively healthy controls undergoing elective surgery, together with 73 Alzheimer's disease (AD) dementiapatients, were recruited at Oslo University Hospital and Diakonhjemmet Hospital, Oslo, Norway. Delirium was evaluated daily in hip fracturepatients by the Confusion Assessment Method (CAM). Depression was evaluated by Cornell Scale for Depression in Dementia (CSDD). Tumor necrosis factor alpha (TNF-α), interleukin-1beta (IL-1β), and interleukin-8 (IL-8) levels were measured in CSF using a Mesoscale Discovery (MSD) immunoassay. RESULTS:Hip fracturepatients had significantly higher IL-8 levels (p < 0.001) compared to cognitively healthy controls or patients with stable ADdementia. Furthermore, preoperative IL-8 levels were significantly higher (p = 0.013) in hip fracturepatients who developed delirium (incident delirium) after surgery as compared to patients with no delirium. However, subgroup analyses showed that IL-8 levels were only significantly higher in deliriumpatients without dementia (p = 0.006). In contrast, depression subgroup analysis showed that IL-8 concentration was significantly higher (p = 0.002) in deliriumpatients with depression. Both TNF-α and IL-1β were undetected in most patients. CONCLUSIONS: Our study suggests that IL-8 levels are associated with delirium onset and that underlying depression or dementia influences IL-8 levels.
Authors: Ariane Lewis; Jennifer Frontera; Dimitris G Placantonakis; Jennifer Lighter; Steven Galetta; Laura Balcer; Kara R Melmed Journal: J Neurol Sci Date: 2021-01-10 Impact factor: 3.181
Authors: Michael Fertleman; Christopher Pereira; Melanie Dani; Benjamin H L Harris; Matteo Di Giovannantonio; Simon D Taylor-Robinson Journal: Sci Rep Date: 2022-02-09 Impact factor: 4.996