Department of Anesthesiology, Division of Anesthesiology Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, United States.
Section of Surgical Sciences, Departments of Surgery, Neurosurgery, and Hearing & Speech Sciences, Division of Trauma and Surgical Critical Care, Vanderbilt Brain Institute, Center for Health Services Research, Vanderbilt University Medical Center, Nashville Veterans Affairs Medical Center, Tennessee Valley Healthcare System, United States.
J Crit Care. 2020 Apr;56:94-99. doi: 10.1016/j.jcrc.2019.12.010. Epub 2019 Dec 16.
Delirium is prevalent but with unclear pathogenesis. Neuronal injury repair pathways may be protective. We hypothesized that higher concentrations of neuronal repair biomarkers would be associated with decreased delirium in critically ill patients.
We performed a nested study of hospital survivors within a prospective cohort that enrolled patients within 72 h of respiratory failure or shock. We measured plasma concentrations of ubiquitin carboxyl-terminal-esterase-L1 (UCHL1) and brain-derived neurotrophic factor (BDNF) from blood collected at enrollment. Delirium was assessed twice daily using the CAM-ICU. Multivariable regression was used to examine the associations between biomarkers and delirium prevalence/duration, adjusting for covariates and interactions with age and IL-6 plasma concentration.
We included 427 patients with a median age of 59 years (IQR 48-69) and APACHE II score of 25 (IQR 19-30). Higher plasma concentration of UCHL1 on admission was independently associated with lower prevalence of delirium (p = .04) but not associated with duration of delirium (p = .06). BDNF plasma concentration was not associated with prevalence (p = .26) or duration of delirium (p = .36).
During critical illness, higher UCHL1 plasma concentration is associated with lower prevalence of delirium; BDNF plasma concentration is not associated with delirium. Clinical trial number: NCT00392795; https://clinicaltrials.gov/ct2/show/NCT00392795.
谵妄较为普遍，但发病机制尚不清楚。神经元损伤修复途径可能具有保护作用。我们假设，危重患者中神经元修复生物标志物浓度较高与谵妄发生率降低相关。
我们对前瞻性队列中住院幸存者进行了嵌套研究，该队列纳入了呼吸衰竭或休克后 72 小时内的患者。我们在入组时采集血液，测量了泛素羧基末端酯酶-L1（UCHL1）和脑源性神经营养因子（BDNF）的血浆浓度。使用 ICU 意识模糊评估法（CAM-ICU）每天评估两次谵妄。采用多变量回归分析，调整协变量以及与年龄和白细胞介素 6（IL-6）血浆浓度的相互作用，以研究生物标志物与谵妄发生率/持续时间之间的关系。
我们纳入了 427 例患者，中位年龄为 59 岁（四分位距 48-69），急性生理学与慢性健康状况评分系统Ⅱ（APACHE Ⅱ）评分为 25 分（四分位距 19-30）。入院时 UCHL1 血浆浓度较高与谵妄发生率较低独立相关（p=0.04），但与谵妄持续时间无关（p=0.06）。BDNF 血浆浓度与发生率（p=0.26）或持续时间（p=0.36）均无相关性。
在危重病期间，较高的 UCHL1 血浆浓度与谵妄发生率较低相关；BDNF 血浆浓度与谵妄无关。临床试验编号：NCT00392795；https://clinicaltrials.gov/ct2/show/NCT00392795。
