Bögli Stefan Yu, Capone Crescenzo, Baumgartner Markus R, Quednow Boris B, Kraemer Thomas, Keller Emanuela, Binz Tina Maria
Neurocritical Care Unit, Institute for Intensive Care Medicine and Department of Neurosurgery, University Hospital Zurich, University Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.
Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich, University Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland.
Neurocrit Care. 2025 Feb;42(1):164-174. doi: 10.1007/s12028-024-02052-9. Epub 2024 Jul 16.
In intensive care, delirium is frequent, prolongs the stay, increases health care costs, and worsens patient outcome. Several substances and medications as well as stress can impact the risk of delirium; however, assessment of previous exposure to psychotropic agents and stress by self-reports or third-party information is not always reliable. Hair analysis can be used to objectively assess medication and substance use (including chronic alcohol consumption), and allows for the determination of stress-related long-term changes in steroid hormones and endocannabinoids.
Consecutive adult patients with acute brain injury admitted to the neurocritical care unit were included. Delirium was diagnosed using the Confusion Assessment Method for the Intensive Care Unit. Liquid chromatography coupled with tandem mass spectrometry was used to investigate psychoactive substances and medications, ethyl glucuronide, steroid hormones, and endocannabinoids in hair samples. Univariable and multivariable analyses were used to reveal any associations with the occurrence of delirium.
Of 50 consecutive patients, 21 (42%) were diagnosed with delirium. Detection of antipsychotics or antidepressants in hair was more frequent in patients with delirium (antidepressants: 43% vs. 14%, p = 0.040; antipsychotics: 29% vs. 0%, p = 0.021). These patients also displayed higher ethyl glucuronide levels (p = 0.049). Anandamide (AEA) concentrations were higher in patients with delirium (p = 0.005), whereas oleoylethanolamide (p = 0.045) and palmitoylethanolamide (PEA) (p = 0.017) concentrations were lower in patients with delirium. Backward stepwise logistic regression analysis revealed antidepressants and AEA/PEA to be independent relevant predictors of delirium.
Hair analysis provides crucial and otherwise unattainable information regarding chronic stress and the use of psychotropic substances and medications. Undisclosed antidepressant/antipsychotic use or intense chronic alcohol consumption is susceptible to treatment (continuation of medication or provision of low-dose benzodiazepines in case of alcohol). Chronic stress can be evaluated using stress markers and endocannabinoids in hair, potentially allowing for personalized delirium risk stratification and preventive measures.
在重症监护中，谵妄很常见，会延长住院时间，增加医疗费用，并使患者预后恶化。多种物质、药物以及应激都可能影响谵妄风险；然而，通过自我报告或第三方信息来评估既往精神药物暴露和应激情况并不总是可靠的。毛发分析可用于客观评估药物和物质使用情况（包括长期酒精摄入），并能确定与应激相关的类固醇激素和内源性大麻素的长期变化。
纳入连续入住神经重症监护病房的成年急性脑损伤患者。使用重症监护病房意识模糊评估法诊断谵妄。采用液相色谱-串联质谱法检测毛发样本中的精神活性物质、药物、葡萄糖醛酸乙酯、类固醇激素和内源性大麻素。采用单变量和多变量分析来揭示与谵妄发生的任何关联。
在连续的50例患者中，21例（42%）被诊断为谵妄。谵妄患者毛发中抗精神病药物或抗抑郁药物的检出率更高（抗抑郁药物：43% 对14%，p = 0.040；抗精神病药物：29% 对0%，p = 0.021）。这些患者的葡萄糖醛酸乙酯水平也更高（p = 0.049）。谵妄患者的花生四烯乙醇胺（AEA）浓度更高（p = 0.005），而谵妄患者的油酰乙醇胺（p = 0.045）和棕榈酰乙醇胺（PEA）（p = 0.017）浓度更低。向后逐步逻辑回归分析显示抗抑郁药物和AEA/PEA是谵妄的独立相关预测因素。
毛发分析提供了关于慢性应激以及精神活性物质和药物使用的关键且难以通过其他方式获得的信息。未披露的抗抑郁药/抗精神病药使用或大量长期酒精摄入易于治疗（继续用药或在酒精摄入情况下给予低剂量苯二氮䓬类药物）。可使用毛发中的应激标志物和内源性大麻素评估慢性应激，这可能有助于进行个性化的谵妄风险分层和预防措施。
