Internal Medicine Unit, Tenerife, Spain.
Laboratory, Canary Islands University Hospital, Tenerife, Spain.
Geriatr Gerontol Int. 2017 Aug;17(8):1161-1167. doi: 10.1111/ggi.12842. Epub 2016 Jul 19.
To analyze the prognostic impact of short-term changes in the intensity of delirium in association or not with sepsis. We also aimed to analyze if s100B, a serum protein derived from astrocytes related to cerebral damage, could be a marker of delirium or sepsis.
We included 47 patients with acute delirium and sepsis, 36 with delirium and no evidence of infection, and 36 patients with sepsis without delirium. The diagnosis of delirium was established by the Confusion Assessment Method. To evaluate delirium, we recorded the following characteristics on the first and third day after admission: level of consciousness, orientation, attention, hallucinations, psychomotor activity, language and disorganized thinking.
In 53 patients, delirium improved during hospitalization with 3.8% of mortality, whereas in the 30 patients in which delirium did not improve or worsened, 50% died during hospitalization. The improvement on the third day of consciousness, orientation, attention and disorganized thinking was related to a better long-term survival. s100B and inflammatory markers tumor necrosis factor-α, interleukin-6, interleukin-10 and interferon-γ were increased in patients with sepsis and confusion when compared with control participants; furthermore, s100B, interleukin-6 and interferon-γ were increased in septic patients without confusion, but also in delirious patients without sepsis.
The main factor related to mortality was the recovery from delirium during hospitalization. We found increased s100B serum levels in patients with delirium, but also in septic patients without delirium. This increase was not related to mortality. Geriatr Gerontol Int 2017; 17: 1161-1167.
分析短期谵妄严重程度变化与脓毒症相关或不相关的预后影响。我们还旨在分析血清蛋白 S100B 是否可作为谵妄或脓毒症的标志物，S100B 是一种源自与脑损伤相关的星形胶质细胞的血清蛋白。
我们纳入了 47 例急性谵妄合并脓毒症患者、36 例单纯谵妄而无感染证据的患者和 36 例无谵妄但合并脓毒症的患者。采用意识模糊评估法（CAM）来诊断谵妄。为了评估谵妄，我们在入院后第 1 天和第 3 天记录了以下特征：意识水平、定向力、注意力、幻觉、精神运动活动、语言和思维紊乱。
在 53 例患者中，谵妄在住院期间得到改善，死亡率为 3.8%，而在 30 例谵妄未改善或恶化的患者中，50%在住院期间死亡。第 3 天意识、定向力、注意力和思维紊乱的改善与长期生存预后较好相关。与对照组相比，合并脓毒症且出现意识模糊的患者的 S100B 和炎症标志物肿瘤坏死因子-α、白细胞介素-6、白细胞介素-10 和干扰素-γ均升高；此外，无意识模糊的脓毒症患者和合并脓毒症的谵妄患者的 S100B、白细胞介素-6 和干扰素-γ也升高。
与死亡率相关的主要因素是住院期间谵妄的恢复。我们发现，在谵妄患者中，S100B 血清水平升高，而在无谵妄的脓毒症患者中也升高。这种增加与死亡率无关。
