Department of Neurology, Jagiellonian University Medical College, ul. Botaniczna 3, 31-503, Krakow, Poland.
Department of Clinical Immunology, Institute of Paediatrics, Jagiellonian University Medical College, Krakow, Poland.
J Neuroinflammation. 2018 Apr 18;15(1):111. doi: 10.1186/s12974-018-1156-y.
Experimental studies suggest that systemic inflammation contributes to the pathophysiology of delirium. The aim of our study was to determine blood-derived inflammatory signatures of post-stroke delirium.
We included 144 ischemic stroke patients. We assessed delirium on a daily basis during the first 7 days of hospitalization. Venous blood was collected at day 3 after the onset of stroke and stimulated ex vivo with lipopolysaccharide (LPS). We measured LPS-induced cytokine concentration (TNFα, IP-10, IL-1β, IL-6, IL-8, IL-10, and IL-12p70) as well as plasma levels of IL-6 and TNFα.
Delirium was diagnosed in 21.5% of patients. After correction for monocyte count, patients with delirium had reduced LPS-induced TNFα, IP-10, IL-1β, IL-6, and IL-12 release. The plasma IL-6 level was higher in delirious patients compared to patients without delirium. After adjusting for stroke severity and infections, higher ex vivo TNFα (OR 0.29, 95%CI 0.11-0.72, P = 0.01), IP-10 (OR 0.25, 95%CI 0.08-0.73, P = 0.01), IL-1β (OR 0.42, 95%CI 0.20-0.89, P = 0.02), and IL-12 (OR 0.07, 95%CI 0.01-0.70, P = 0.02) release was associated with the reduced risk of delirium. In multivariate analysis, the higher plasma IL-6 was associated with the increased risk of delirium (OR 1.61, 95%CI 1.00-2.58, P = 0.04).
Reduced ex vivo release of pro-inflammatory cytokines after LPS stimulation and the elevated plasma IL-6 are signatures of post-stroke delirium.
实验研究表明，全身炎症反应与谵妄的病理生理学有关。我们的研究目的是确定中风后谵妄的血液炎症特征。
我们纳入了 144 名缺血性脑卒中患者。在住院的头 7 天内，我们每天对谵妄进行评估。在中风发病后第 3 天采集静脉血，体外用脂多糖（LPS）刺激。我们测量了 LPS 诱导的细胞因子浓度（TNFα、IP-10、IL-1β、IL-6、IL-8、IL-10 和 IL-12p70）以及血浆中 IL-6 和 TNFα 的水平。
21.5%的患者被诊断为谵妄。校正单核细胞计数后，谵妄患者 LPS 诱导的 TNFα、IP-10、IL-1β、IL-6 和 IL-12 释放减少。与无谵妄的患者相比，谵妄患者的血浆 IL-6 水平更高。在调整了中风严重程度和感染后，更高的体外 TNFα（OR 0.29，95%CI 0.11-0.72，P=0.01）、IP-10（OR 0.25，95%CI 0.08-0.73，P=0.01）、IL-1β（OR 0.42，95%CI 0.20-0.89，P=0.02）和 IL-12（OR 0.07，95%CI 0.01-0.70，P=0.02）释放与谵妄风险降低相关。多变量分析显示，血浆中较高的 IL-6 与谵妄的风险增加有关（OR 1.61，95%CI 1.00-2.58，P=0.04）。
LPS 刺激后促炎细胞因子的体外释放减少和血浆中 IL-6 的升高是中风后谵妄的特征。
