Division of Geriatrics, Department of Internal Medicine, Gulhane Faculty of Medicine, University of Health Sciences, Gulhane Training and Research Hospital, 06010, Ankara, Turkey.
Aging Clin Exp Res. 2022 Aug;34(8):1819-1826. doi: 10.1007/s40520-022-02108-w. Epub 2022 Mar 23.
Delirium superimposed on dementia (DSD) is associated with adverse outcomes in older adults. Nonetheless, little is known about the association between inflammatory markers and clinical outcomes of DSD.
This research investigated the predictive value of the neutrophil-to-lymphocyte ratio (NLR) for short- and long-term mortality among community-dwelling older adults with DSD.
This retrospective cohort study included 9755 older outpatients who were referred to a tertiary hospital between January 2010 and June 2021. All patients underwent a comprehensive geriatric assessment and routine laboratory tests. Delirium and dementia was diagnosed with the DSM-4 or DSM-5 criteria. We recorded information on mortality during 1 year following the delirium episode.
Among 615 patients with dementia, 170 (26.3%) had delirium. Patients with delirium were predominantly older, with higher Deyo-Charlson comorbidity index scores, lower general cognitive performance, lower functional capability, and higher anticholinergic burden compared to those without delirium. At the 1-year follow-up, the mortality rate of DSD was 29.3%. Multivariate analysis showed that NLR at admission was an independent predictor of 1-month mortality (HR = 1.03; 95% CI 1.00-1.05; p = 0.04) and 1-year mortality (HR = 1.02; 95% CI 1.01-1.05; p = 0.01) of DSD patients.
NLR can predict prognosis in various diseases including cardiovascular disease, malignancies, and cerebrovascular disease, but as yet there is no similar prognostic measure in delirium. Moreover, recent previous studies demonstrated NLR is a potential marker for the prediction of delirium in older adults with different clinical settings. In the current study, we demonstrated that NLR is also a prognostic marker for DSD.
NLR could be useful marker for predicting short- and long-term mortality in patients with DSD. However, further studies are needed to validate these findings.
痴呆合并谵妄（DSD）与老年人的不良预后相关。尽管如此，人们对炎症标志物与 DSD 的临床结局之间的关系知之甚少。
本研究旨在探讨中性粒细胞与淋巴细胞比值（NLR）对社区居住的 DSD 老年患者短期和长期死亡率的预测价值。
这是一项回顾性队列研究，纳入了 2010 年 1 月至 2021 年 6 月期间在一家三级医院就诊的 9755 名老年门诊患者。所有患者均接受了全面老年评估和常规实验室检查。使用 DSM-4 或 DSM-5 标准诊断谵妄和痴呆。我们记录了谵妄发作后 1 年内的死亡率信息。
在 615 名痴呆患者中，有 170 名（26.3%）患有谵妄。与无谵妄的患者相比，患有谵妄的患者年龄更大，德约-查尔森共病指数评分更高，总体认知表现更差，功能能力更低，抗胆碱能药物负担更高。在 1 年随访时，DSD 的死亡率为 29.3%。多变量分析显示，入院时的 NLR 是 1 个月死亡率（HR=1.03；95%CI 1.00-1.05；p=0.04）和 1 年死亡率（HR=1.02；95%CI 1.01-1.05；p=0.01）的独立预测因素。
NLR 可预测包括心血管疾病、恶性肿瘤和脑血管疾病在内的各种疾病的预后，但目前在谵妄中尚无类似的预后指标。此外，最近的一些研究表明，NLR 是预测不同临床环境下老年患者谵妄的潜在标志物。在本研究中，我们证明 NLR 也是 DSD 的预后标志物。
NLR 可能是预测 DSD 患者短期和长期死亡率的有用标志物。然而，需要进一步的研究来验证这些发现。
