Michael E Reznik1, Roshini Kalagara2, Scott Moody2, Jonathan Drake2, Seth A Margolis3, Sevdenur Cizginer4, Ali Mahta5, Shyam S Rao5, Christoph Stretz5, Linda C Wendell6, Bradford B Thompson5, Wael F Asaad7, Karen L Furie2, Richard N Jones8, Lori A Daiello2. 1. Department of Neurology, Brown University, Alpert Medical School, Providence, RI, USA; Department of Neurosurgery, Brown University, Alpert Medical School, Providence, RI, USA. Electronic address: Michael_Reznik@brown.edu. 2. Department of Neurology, Brown University, Alpert Medical School, Providence, RI, USA. 3. Department of Psychiatry, Brown University, Alpert Medical School, Providence, RI, USA. 4. Department of Medicine, Brown University, Alpert Medical School, Providence, RI, USA. 5. Department of Neurology, Brown University, Alpert Medical School, Providence, RI, USA; Department of Neurosurgery, Brown University, Alpert Medical School, Providence, RI, USA. 6. Department of Neurology, Brown University, Alpert Medical School, Providence, RI, USA; Department of Neurosurgery, Brown University, Alpert Medical School, Providence, RI, USA; Section of Medical Education, Brown University, Alpert Medical School, Providence, RI, USA. 7. Department of Neurosurgery, Brown University, Alpert Medical School, Providence, RI, USA. 8. Department of Neurology, Brown University, Alpert Medical School, Providence, RI, USA; Department of Psychiatry, Brown University, Alpert Medical School, Providence, RI, USA.
Abstract
PURPOSE: To examine associations between physiologic stress and delirium in the setting of a direct neurologic injury. MATERIALS AND METHODS: We obtained initial neutrophil-to-lymphocyte ratio (NLR), glucose, and troponin in consecutive non-comatose patients with non-traumatic intracerebral hemorrhage (ICH) over 1 year, then used multivariable regression models to determine associations between each biomarker and incident delirium. Delirium diagnoses were established using DSM-5-based methods, with exploratory analyses further categorizing delirium as first occurring <24 h ("early-onset") or > 24 h after presentation ("later-onset"). RESULTS: Of 284 patients, delirium occurred in 55% (early-onset: 39% [n = 111]; later-onset: 16% [n = 46]). Patients with delirium had higher NLR (mean 9.0 ± 10.4 vs. 6.4 ± 5.5; p = 0.01), glucose (mean 146.5 ± 59.6 vs. 129.9 ± 41.4 mg/dL; p = 0.008), and a higher frequency of elevated troponin (>0.05 ng/mL; 21% vs. 10%, p = 0.02). In adjusted models, elevated NLR (highest quartile: OR 3.4 [95% CI 1.5-7.8]), glucose (>180 mg/dL: OR 3.1 [95% CI 1.1-8.2]), and troponin (OR 3.0 [95% CI 1.2-7.2]) were each associated with delirium, but only initial NLR was specifically associated with later-onset delirium and with delirium in non-mechanically ventilated patients. CONCLUSIONS: Stress-related biomarkers corresponding to multiple organ systems are associated with ICH-related delirium. Early NLR elevation may also predict delayed-onset delirium, potentially implicating systemic inflammation as a contributory delirium mechanism.
PURPOSE: To examine associations between physiologic stress and delirium in the setting of a direct neurologic injury. MATERIALS AND METHODS: We obtained initial neutrophil-to-lymphocyte ratio (NLR), glucose, and troponin in consecutive non-comatose patients with non-traumatic intracerebral hemorrhage (ICH) over 1 year, then used multivariable regression models to determine associations between each biomarker and incident delirium. Delirium diagnoses were established using DSM-5-based methods, with exploratory analyses further categorizing delirium as first occurring <24 h ("early-onset") or > 24 h after presentation ("later-onset"). RESULTS: Of 284 patients, delirium occurred in 55% (early-onset: 39% [n = 111]; later-onset: 16% [n = 46]). Patients with delirium had higher NLR (mean 9.0 ± 10.4 vs. 6.4 ± 5.5; p = 0.01), glucose (mean 146.5 ± 59.6 vs. 129.9 ± 41.4 mg/dL; p = 0.008), and a higher frequency of elevated troponin (>0.05 ng/mL; 21% vs. 10%, p = 0.02). In adjusted models, elevated NLR (highest quartile: OR 3.4 [95% CI 1.5-7.8]), glucose (>180 mg/dL: OR 3.1 [95% CI 1.1-8.2]), and troponin (OR 3.0 [95% CI 1.2-7.2]) were each associated with delirium, but only initial NLR was specifically associated with later-onset delirium and with delirium in non-mechanically ventilated patients. CONCLUSIONS: Stress-related biomarkers corresponding to multiple organ systems are associated with ICH-related delirium. Early NLR elevation may also predict delayed-onset delirium, potentially implicating systemic inflammation as a contributory delirium mechanism.
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