Bassi Thiago, Rohrs Elizabeth, Nicholas Michelle, Reynolds Steven
Lungpacer Medical USA Inc., Exton, PA, United States.
Advancing Innovation in Medicine Institute, New Westminster, BC, Canada.
Front Neurol. 2023 Jun 9;14:1179243. doi: 10.3389/fneur.2023.1179243. eCollection 2023.
Identifying biomarkers that, at hospital admission, predict subsequent delirium will help to focus our clinical efforts on prevention and management.
The study aimed to investigate biomarkers at hospital admission that may be associated with delirium during hospitalization.
A librarian at the Fraser Health Authority Health Sciences Library performed searches from 28 June 2021 to 9 July 2021, using the following sources: Medline, EMBASE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Cochrane Methodology Register, and the Database of Abstracts of Reviews and Effects.
The inclusion criteria were articles in English that investigated the link between serum concentration of biomarkers at hospital admission and delirium during hospitalization. Exclusion criteria were single case reports, case series, comments, editorials, letters to the editor, articles that were not relevant to the review objective, and articles concerning pediatrics. After excluding duplicates, 55 studies were included.
This meta-analysis followed the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) protocol. Independent extraction, with the consensus of multiple reviewers, was used to determine the final studies included. The weight and heterogeneity of the manuscripts were calculated using inverse covariance with a random-effects model.
Differences in mean serum concentration of biomarkers at hospital admission between patients who did and did not develop delirium during hospitalization.
Our search found evidence that patients who developed delirium during hospitalization had, at hospital admission, significantly greater concentrations of certain inflammatory biomarkers and one blood-brain barrier leakage marker than patients who did not develop delirium during hospitalization (differences in the mean: cortisol: 3.36 ng/ml, < 0.0001; CRP: 41.39 mg/L, < 0.00001; IL-6: 24.05 pg/ml, < 0.00001; S100β 0.07 ng/ml, < 0.00001). These differences were independent of other confounding variables such as the patient's severity of illness. A significantly lower serum concentration, at hospital admission, of acetylcholinesterase (difference in the means -0.86 U/ml, = 0.004) was also associated with an increased vulnerability to developing delirium during hospitalization.
Our meta-analysis supports the hypothesis that patients with hypothalamic-pituitary axis dysfunction, increased blood-brain barrier permeability, and chronic overload of the cholinergic system, at hospital admission, are more vulnerable to developing delirium during hospitalization.
识别在入院时可预测随后谵妄的生物标志物，将有助于我们把临床工作重点放在预防和管理上。
本研究旨在调查入院时可能与住院期间谵妄相关的生物标志物。
弗雷泽卫生局健康科学图书馆的一名馆员于2021年6月28日至2021年7月9日进行了检索，使用了以下来源：医学文献数据库、荷兰医学文摘数据库、Cochrane系统评价数据库、Cochrane对照试验中心注册库、Cochrane方法学注册库以及循证医学数据库。
纳入标准为用英文撰写的、调查入院时生物标志物血清浓度与住院期间谵妄之间联系的文章。排除标准为单病例报告、病例系列、评论、社论、给编辑的信、与综述目标无关的文章以及涉及儿科的文章。在排除重复项后，纳入了55项研究。
本荟萃分析遵循系统评价和荟萃分析的首选报告项目（PRISMA）方案。采用独立提取，并经多名评审员达成共识，以确定最终纳入的研究。使用随机效应模型的逆协方差计算稿件的权重和异质性。
住院期间发生谵妄的患者与未发生谵妄的患者在入院时生物标志物平均血清浓度的差异。
我们的检索发现，有证据表明，住院期间发生谵妄的患者在入院时某些炎症生物标志物和一种血脑屏障渗漏标志物的浓度显著高于住院期间未发生谵妄的患者（均值差异：皮质醇：3.36 ng/ml，P<0.0001；C反应蛋白：41.39 mg/L，P<0.00001；白细胞介素-6：24.05 pg/ml，P<0.00001；S100β 0.07 ng/ml，P<0.00001）。这些差异与其他混杂变量（如患者的疾病严重程度）无关。入院时乙酰胆碱酯酶血清浓度显著降低（均值差异-0.86 U/ml，P=0.004）也与住院期间发生谵妄的易感性增加有关。
我们的荟萃分析支持以下假设：入院时下丘脑-垂体轴功能障碍、血脑屏障通透性增加以及胆碱能系统慢性负荷过重的患者，在住院期间更易发生谵妄。
