The Lithuanian University of Health Sciences, Kaunas, Lithuania (Nekrosius, Lideikis); the Neuroscience Institute, Lithuanian University of Health Sciences, Kaunas, Lithuania (Kaminskaite, Jokubka, Pranckeviciene, Tamasauskas, Bunevicius); and the Department of Neurosurgery at Kauno Klinikos, Lithuanian University of Health Sciences, Kaunas, Lithuania (Tamasauskas, Bunevicius).
J Neuropsychiatry Clin Neurosci. 2019 Fall;31(4):298-305. doi: 10.1176/appi.neuropsych.18080195. Epub 2019 May 3.
The authors investigated the association of the catechol--methyltransferase (COMT) gene ValMet polymorphism with delirium risk and functional and cognitive outcomes among patients with complicated mild to moderate traumatic brain injury (TBI).
In a prospective observational cohort study, patients were monitored for occurrence of delirium during the first 4 days of admission by using the Confusion Assessment Method. Functional and cognitive outcomes were evaluated with the Glasgow Outcome on Discharge Scale and the Montreal Cognitive Assessment test, respectively. Eighty-nine patients were included in the study; of these, 17 (19%) were diagnosed with delirium.
The COMT Val/Val polymorphism was associated with increased risk of delirium in multivariable regression analyses adjusted for alcohol misuse, history of neurological disorder, age, and admission Glasgow Coma Scale score (odds ratio=4.57, 95% CI=1.11, 18.9, p=0.036). The COMT Met allele was associated with better functional outcomes in univariate analysis (odds ratio=2.82, 95% CI=1.10, 7.27, p=0.031) but not in multivariable analysis (odds ratio=2.33, 95% CI=0.89, 6.12, p=0.085). Cognitive outcomes were not associated with the COMT ValMet polymorphism in univariate regression analysis (p=0.390). Delirium was a significant predictor of worse functional and cognitive outcomes in multivariable regression analyses adjusted for other risk factors (odds ratio=0.04, 95% CI=0.01, 0.16, p<0.001, and β=-3.889, 95% CI=-7.55, -0.23, p=0.038, respectively).
The COMT genotype is important in delirium risk and functional outcomes of patients with mild to moderate TBI. Whether the COMT genotype is associated with outcomes through incident delirium remains to be determined in larger studies.
作者研究了儿茶酚-O-甲基转移酶（COMT）基因 ValMet 多态性与伴有轻度至中度复杂性创伤性脑损伤（TBI）患者谵妄风险以及功能和认知结局的关系。
在一项前瞻性观察队列研究中，通过使用意识混乱评估方法（CAM）在入院的前 4 天内监测患者谵妄的发生情况。分别使用格拉斯哥出院量表（GOS）和蒙特利尔认知评估测试（MoCA）评估功能和认知结局。该研究共纳入 89 例患者，其中 17 例（19%）被诊断为谵妄。
多变量回归分析调整了酒精滥用、神经病史、年龄和入院格拉斯哥昏迷量表评分后，COMT Val/Val 多态性与谵妄风险增加相关（比值比=4.57，95%CI=1.11，18.9，p=0.036）。在单变量分析中，COMT Met 等位基因与功能结局更好相关（比值比=2.82，95%CI=1.10，7.27，p=0.031），但在多变量分析中则不然（比值比=2.33，95%CI=0.89，6.12，p=0.085）。在单变量回归分析中，认知结局与 COMT ValMet 多态性无关（p=0.390）。在调整其他危险因素的多变量回归分析中，谵妄是功能和认知结局较差的显著预测因子（比值比=0.04，95%CI=0.01，0.16，p<0.001，β=-3.889，95%CI=-7.55，-0.23，p=0.038）。
COMT 基因型在伴有轻度至中度 TBI 患者的谵妄风险和功能结局中很重要。COMT 基因型是否通过发生谵妄与结局相关，还需要在更大的研究中确定。
