Pinto Agnes Araújo Sardinha, Carvalho Maira Mello de, Santos Juliana Bahia, Silva Rebeca Souza da, Barbeiro Hermes Vieira, Gómez Luz Marina Gómez, Maia Ian Ward Abdalla, Marchini Júlio Flávio Meirelles, Garcez Flávia Barreto, Avelino-Silva Thiago Junqueira, Soler Lucas de Moraes, Mochetti Matheus Menão, Souza Heraldo Possolo de, Alencar Júlio Cesar Garcia
Discipline of Clinical Emergencies, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
Faculdade de Medicina de Bauru, Universidade de São Paulo, Bauru, SP, Brazil.
Einstein (Sao Paulo). 2025 Apr 7;23:eAO1244. doi: 10.31744/einstein_journal/2025AO1244. eCollection 2025.
In this study, Pinto et al. identified significantly higher levels of neuron-specific enolase and Tau protein in older patients with sepsis-associated delirium in the emergency department, suggesting the potential of these biomarkers as diagnostic tools in this population.
Sepsis-associated delirium is a common cerebral manifestation in patients with sepsis, potentially caused by a combination of neuroinflammation and other neurophysiological disorders. This study investigated the expression of neuron-specific enolase and Tau protein as biomarkers in patients with sepsis-associated delirium. While neuron-specific enolase and Tau protein are known to be associated with brain injury, their diagnostic potential in patients with sepsis-associated delirium is not well understood.
This cross-sectional pilot study evaluated plasma levels of neuron-specific enolase and Tau protein in patients with delirium and sepsis to explore their potential for identifying sepsis in patients admitted to the emergency department.
A total of 25 patients with delirium were analyzed, 56% of whom had sepsis. Patients with sepsis exhibited significantly higher neuron-specific enolase levels (2.7ng/mL [95%CI= 2.2-3.2] versus 1.3 ng/mL [95%CI= 0.8-2.5], p<0.003) and Tau protein levels (96.1pg/mL [95%CI= 77.0-111.3] versus 43.0pg/mL [95%CI= 31.2-84.5], p<0.003) compared to patients without sepsis. Neuron-specific enolase and Tau protein thresholds of >2.08ng/mL and >59.27pg/mL, respectively, demonstrated 90% specificity for identifying sepsis in patients.
Neuron-specific enolase and Tau protein levels were significantly higher in patients with sepsis than in those without, underscoring their potential ability to identify the infectious etiology of delirium in older patients admitted to emergency departments. Clinical Trials #RBR-233bct.
■ Biomarkers of brain injury, such as neuron-specific enolase and Tau proteins, are higher in older patients with sepsis and delirium.
■ Diagnosing sepsis in patients with delirium can be challenging.
■ Early identification of sepsis is key to managing sepsisassociated delirium.
在本研究中，平托等人发现急诊科中患有脓毒症相关性谵妄的老年患者体内神经元特异性烯醇化酶和 Tau 蛋白水平显著升高，这表明这些生物标志物有可能作为该人群的诊断工具。
脓毒症相关性谵妄是脓毒症患者常见的脑部表现，可能由神经炎症和其他神经生理紊乱共同引起。本研究调查了神经元特异性烯醇化酶和 Tau 蛋白作为脓毒症相关性谵妄患者生物标志物的表达情况。虽然已知神经元特异性烯醇化酶和 Tau 蛋白与脑损伤有关，但其在脓毒症相关性谵妄患者中的诊断潜力尚未得到充分了解。
这项横断面试点研究评估了谵妄和脓毒症患者血浆中神经元特异性烯醇化酶和 Tau 蛋白的水平，以探讨它们在识别急诊科入院患者脓毒症方面的潜力。
共分析了 25 例谵妄患者，其中 56%患有脓毒症。与无脓毒症患者相比，脓毒症患者的神经元特异性烯醇化酶水平（2.7ng/mL [95%CI = 2.2 - 3.2] 对 1.3 ng/mL [95%CI = 0.8 - 2.5]，p < 0.003）和 Tau 蛋白水平（96.1pg/mL [95%CI = 77.0 - 111.3] 对 43.0pg/mL [95%CI = 31.2 - 84.5]，p < 0.003）显著更高。神经元特异性烯醇化酶和 Tau 蛋白阈值分别 >2.08ng/mL 和 >59.27pg/mL 时，在识别患者脓毒症方面显示出 90%的特异性。
脓毒症患者的神经元特异性烯醇化酶和 Tau 蛋白水平显著高于无脓毒症患者，这突出了它们在识别急诊科老年入院患者谵妄感染病因方面的潜在能力。临床试验编号：#RBR - 233bct。
■ 脑损伤生物标志物，如神经元特异性烯醇化酶和 Tau 蛋白，在患有脓毒症和谵妄的老年患者中水平更高。
■ 诊断谵妄患者的脓毒症可能具有挑战性。
■ 早期识别脓毒症是管理脓毒症相关性谵妄的关键。
