Preoperative cerebrospinal fluid cytokine levels and the risk of postoperative delirium in elderly hip fracture patients

Journal of Neuroinflammation

Willem A van Gool¹  Piet Eikelenboom⁶  Diederik van de Beek¹  David J van Westerloo²  Alasdair M J MacLullich⁴  Inge C M Hoogland¹  Alexander P J Houdijk⁷  Mireille F M van Stijn⁷  Jos F M de Jonghe³  Kees J Kalisvaart⁵  Leo Koenderman⁸  Joost Witlox³  Dunja Westhoff¹ 

[1] Department of Neurology, Academic Medical Center/University of Amsterdam, PO box 22660, 1100 DD Amsterdam, the Netherlands;Department of Intensive Care Medicine, University Medical Center Leiden, Leiden, the Netherlands;Department of Geriatrics, Medical Center Alkmaar, Alkmaar, the Netherlands;Edinburgh Delirium Research Group, Geriatric Medicine Unit, University of Edinburgh, Edinburgh, Scotland;Department of Geriatric Medicine, Kennemer Gasthuis, Haarlem, the Netherlands;GGZinGeest, Amsterdam, the Netherlands;Department of Surgery, Medical Center Alkmaar, Alkmaar, the Netherlands;Department of Respiratory Medicine, University Medical Center Utrecht, Utrecht, the Netherlands

关键词: Hip fracture;    Neurodegeneration;    Cerebrospinal fluid;    Neuroinflammation;    Cytokines;    Delirium;   

Others  :  1151873
DOI  :  10.1186/1742-2094-10-122

 received in 2013-07-19, accepted in 2013-09-27,  发布年份 2013

【 摘 要 】

Background

Aging and neurodegenerative disease predispose to delirium and are both associated with increased activity of the innate immune system resulting in an imbalance between pro- and anti-inflammatory mediators in the brain. We examined whether hip fracture patients who develop postoperative delirium have altered levels of inflammatory mediators in cerebrospinal fluid (CSF) prior to surgery.

Methods

Patients were 75 years and older and admitted for surgical repair of an acute hip fracture. CSF samples were collected preoperatively. In an exploratory study, we measured 42 cytokines and chemokines by multiplex analysis. We compared CSF levels between patients with and without postoperative delirium and examined the association between CSF cytokine levels and delirium severity. Delirium was diagnosed with the Confusion Assessment Method; severity of delirium was measured with the Delirium Rating Scale Revised-98. Mann–Whitney U tests or Student t-tests were used for between-group comparisons and the Spearman correlation coefficient was used for correlation analyses.

Results

Sixty-one patients were included, of whom 23 patients (37.7%) developed postsurgical delirium. Concentrations of Fms-like tyrosine kinase-3 (P=0.021), Interleukin-1 receptor antagonist (P=0.032) and Interleukin-6 (P=0.005) were significantly lower in patients who developed delirium postoperatively.

Conclusions

Our findings fit the hypothesis that delirium after surgery results from a dysfunctional neuroinflammatory response: stressing the role of reduced levels of anti-inflammatory mediators in this process.

Trial registration

The Effect of Taurine on Morbidity and Mortality in the Elderly Hip Fracture Patient.

Registration number: NCT00497978. Local ethical protocol number: NL16222.094.07.

【 授权许可】

   
2013 Westhoff et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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