Cortisol, interleukins and S100B in delirium in the elderly

Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Centre, University of Amsterdam, The Netherlands.
Brain and Cognition (Impact Factor: 2.48). 10/2010; 74(1):18-23. DOI: 10.1016/j.bandc.2010.05.010
Source: PubMed


In independent studies delirium was associated with higher levels of cortisol, interleukin(IL)s, and S100B. The aim of this study was to simultaneously compare cortisol, IL-6, IL-8, and S100B levels in patients aged 65years and older admitted for hip fracture surgery with and without delirium. Cortisol, IL-6, IL-8, and S100B were assayed in repeated blood samples. 120 patients (mean age 84years, 62 patients with delirium) were included. Highest levels of IL-8 (27.1, 95% Confidence Interval (CI): 13.6-53.1pg/ml) and cortisol (666, 95% CI: 475-859nmol/L) were before delirium, but of IL-6 (84.3, 95% CI: 46.5-151.4pg/mL) and S100B (0.18, 95% CI: 0.12-0.24 microg/L) during delirium. In multivariable analysis cortisol, LogIL-6, and LogS100B were significantly associated with delirium, but adjusted for pre-existing cognitive impairment, only LogS100B remained significantly associated. Cortisol, IL-6 and S100B may have a role in the pathogenesis of delirium, but S100B is the strongest independent marker.

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Available from: Joke Korevaar, Jan 02, 2014
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    • "Hogevold et al [16] reported that chemical mediators particularly Il-6, CK, TNF-alpha and IL-1 are strongly correlated with muscular injury response and surgery, which supports our opinion. Li et al. [17] found that only elevations in IL-6, S100b, were associated with cognitive impairment and delirium, following hip fracture surgery [17, 18]. Perioperative increase in CRP and inflammatory cytokines such as IL-1 and -10 is associated with neurocognitive deficits (NCD) in patients after cardiopulmonary bypass [6, 19]. "
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    ABSTRACT: Besides brain injury and systemic infection, cognitive and concussion like sickness behaviour is associated with muscular trauma and perioperative patients, which represents a major obstacle to daily activities and rehabilitation. The neuroinflammatory response triggers glial activation and consequently the release of proinflammatory cytokines within the hippocampus. We review clinical studies that have investigated neurocognitive and psychosomatic symptoms related to muscular trauma and in perioperative conditions. These include impaired attention and executive and general cognitive functioning. The purpose of this literature review is to focus on the systemic inflammation and the role of proinflammatory cytokines IL1, IL6,and TNF and other inflammatory mediators which mediates the cognitive impairment and induces sickness behaviour. Moreover, this review will also help to determine if some patients could have long-term cognitive changes associated with musculoskeletal injuries or as a consequence of surgery and thereby will lead to efforts in reducing that risk.
    Full-text · Article · Apr 2014 · Neurology Research International
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    • "Cortisol has been suggested as biomarker for the diagnosis of delirium [7]. High cortisol release associated with delirium was previously reported in stroke [8], in postcardiac surgery [9], in the elderly patients with hip fracture [10], in psychological depression, and in Cushing syndrome [11]. In clinical severe sepsis, high cortisol levels have been reported in patients who developed fatal brain dysfunction [12] but it remained unclear if this could be a sole indicator of severe inflammation and disease severity or was due to brain dysfunction. "
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    ABSTRACT: Objectives: To investigate cortisol levels in brain dysfunction in patients with severe sepsis and septic shock. Methods: In 128 septic and sedated patients, we studied brain dysfunction including delirium and coma by the evaluation of Richmond Agitation Sedation Scale (RASS), the Confusion Method Assessment in the ICU (CAM-ICU) after sedation withdrawal and the measurement of serum S100B biomarker of brain injury. Serum cortisol and S100B were measured within 12 hours after ICU admission and daily over the next four days. Results: Brain dysfunction was observed in 50% (64/128) before but in 84% (107/128) of patients after sedation withdrawal, and was more common in the patients older than 57 years (P = 0.009). Both cortisol (P = 0.007) and S100B levels (P = 0.028) were higher in patients with than patients without brain dysfunction. Cortisol levels were associated with ICU mortality (hazard ratio = 1.17, P = 0.024). Multivariate logistic regression showed that cortisol (odds ratio (OR): 2.34, 95% CI (2.01, 3.22), P = 0.02) and the combination effect of cortisol with age (OR: 1.004, 95% CI (1.002, 1.93), P = 0.038) but not S100B were associated with brain dysfunction. Conclusions: Cortisol was an associated-risk factor of brain dysfunction in patients with severe sepsis and septic shock.
    Full-text · Article · Apr 2014 · BioMed Research International
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    • "Although the mechanism of delirium remains unclear, it has been clearly demonstrated that multiple factors are involved [7, 8]. Besides advanced age, a recent study showed that systemic stress and inflammatory response might play an important role in the development of this condition [9, 10]. It has been reported that the serum levels of an inflammatory biomarkers, including interleukin-6 (IL-6), were positively correlated to the incidence of delirium [11]. "
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    ABSTRACT: This study aims to investigate the role of fast-track surgery in preventing the development of postoperative delirium and other complications in elderly patients with colorectal carcinoma. A total of 240 elderly patients with colorectal carcinoma (aged ≥70 years) undergoing open colorectal surgery was randomly assigned into two groups, in which the patients were managed perioperatively either with traditional or fast-track approaches. The length of hospital stay (LOS) and time to pass flatus were compared. The incidence of postoperative delirium and other complications were evaluated. Serum interleukin-6 (IL-6) levels were determined before and after surgery. The LOS was significantly shorter in the fast-track surgery (FTS) group than that in the traditional group. The recovery of bowel movement (as indicated by the time to pass flatus) was faster in the FTS group. The postoperative complications including pulmonary infection, urinary infection and heart failure were significantly less frequent in the FTS group. Notably, the incidence of postoperative delirium was significantly lower in patients with the fast track therapy (4/117, 3.4 %) than with the traditional therapy (15/116, 12.9 %; p = 0.008). The serum IL-6 levels on postoperative days 1, 2, and 3 in patients with the fast-track therapy were significantly lower than those with the traditional therapy (p < 0.001). Compared to traditional perioperative management, fast-track surgery decreases the LOS, facilitates the recovery of bowel movement, and reduces occurrence of postoperative delirium and other complications in elderly patients with colorectal carcinoma. The lower incidence of delirium is at least partly attributable to the reduced systemic inflammatory response mediated by IL-6.
    Full-text · Article · Dec 2013 · Langenbeck s Archives of Surgery
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