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

• Published in: PloS one Vol. 14; no. 12; p. e0226412
• Main Authors: McNeil, J. Brennan, Hughes, Christopher G., Girard, Timothy, Ware, Lorraine B., Ely, E. Wesley, Chandrasekhar, Rameela, Han, Jin H.
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 19.12.2019; Public Library of Science (PLoS)
• Subjects: Activation; Aged; Aged, 80 and over; Analysis; Biological markers; Biology and Life Sciences; Biomarkers; Biomarkers - blood; Blood; Blood Coagulation; Blood-brain barrier; Blood-Brain Barrier - injuries; Brain; Brain injuries; Brain Injuries - complications; Brain injury; Brain research; Coagulation; Cohort Studies; Critical care; Delirium; Delirium - blood; Delirium - complications; Delirium - diagnosis; Delirium - physiopathology; Dementia; Dementia disorders; Dependent variables; Education; Elderly patients; Emergency medical care; Emergency medical services; Endothelium; Enrollments; Female; Geriatrics; Head injuries; Hospital patients; Hospitalization; Hospitals; Humans; Hypotheses; Illnesses; Inflammation; Inflammation - complications; Injuries; Interleukin; Interleukin 6; Interleukin 8; Interleukins; Male; Medicine; Medicine and Health Sciences; Mental disorders; Necrosis; Pathogenesis; Patients; Plasminogen activator inhibitors; Prognosis; Protein C; Proteins; Regression analysis; S100b protein; Studies; Time Factors; Traumatic brain injury; Tumor necrosis factor; Tumor necrosis factor-TNF; Tumors; United States > US; Tennessee; Nashville Tennessee
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0226412

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