1. Home
  2. Vol 54, No 3 (2022)
  3. Mulyana

The Role of High Sensitivity C-reactive Protein to Predict Delirium Persistence in Elderly Patients with Pneumonia: A Prospective Cohort Study

Roza Mulyana, Yuliarni Syafrita, Hirowati Ali, Arina Widya Murni

Abstract


Background: Delirium is a disorder of acute full attention, and cognitive function commonly occurs at elderly which  can prolong hospitalization, dependence rate, morbidity, and mortality, with pneumonia infection as one of its risk factors. Several markers have been studied for delirium, but relationship between delirium severity and persistence remains unclear. This study aimed to examine the role of hs-CRP, pNF-H, S100B, and NLR to predict delirium persistence.  Methods: A prospective  cohort study was  conducted among 80 subjects who were admitted to the internal ward in dr. M. Djamil Hospital in Padang. Subjects were grouped based on severity of delirium using the Memorial Delirium Assessment Scale and  followed up until discharged to determine delirium persistence event. Results: Mean age of subjects is 70.7±7.4 years, 39 (48.8%) male and 41 (51.2%) female,consisting of 29 mild, 26 moderate, and 25 severe delirium. Levels of hs-CRP in mild, moderate, and severe delirium are 13.36±0.79, 13.56±0.78, and 13.88±0.59 mg/L (p=0.038), respectively. Median NLR values for mild, moderate, severe delirium were 6.80 (1.00-31.00), 9.50 (3.60-46.00), and 11.90 (2.80-46.50) (p=0.026). Cut off value hs-CRP 13.61 mg/L has significant difference for delirium persistence event (OR 2,54; 95% CI 1,01-6,39). Median levels of pNF-H and S100B are not significant in different delirium severity, regardless of non-persistent or persistent. Conclusion:  Hs-CRP levels exceeding 13.61 can predict risk of persistent delirium, but not with levels pNF-H, S100B, and NLR.


Keywords


Delirium persistence; hs-CRP; elderly; pneumonia

References


Inouye SK, Growdon M, Fong T. Delirium. In: Halter JB, Ouslander JG, Studenski S, et al, editors. Hazzard’s geriatric medicine and gerontology. Seventh edition. New York: McGraw Hill. 2017. p. 709-22.

George J, Bleasdale S, Singleton SJ. Causes and prognosis of delirium in elderly patients admitted to a district general hospital. Age and Aging. 1997; 26:423-7.

Aliberti S, Bellelli G, Belotti M, et al. Aging. Clin Exp Res. 2015;27(4):523-31.

Pieralli F, Vannucchi V, Mancini A, et al. Delirium is a predictor of in-hospital mortality in elderly patients with community acquired pneumonia. Intern Emerg Med. 2014;9(2):195-200.

Lee KH, Ha YC, Koo KH. Frequency risk factor and prognosis of prolonged delirium in elderly patients after hip fracture surgery. Clin Orthop Relat Res. 2011;469(9):2612-20.

Cole MG, Ciampi A, Belzile E, Zhong L. Persistent delirium in older hospital patients: a systematic review of frequency and prognosis. Age and Ageing. 2008;38:19-26.

Dillon ST, Vasunillashorn SM, Ngo L, et al. Higher C-reactive protein levels predict postoperative delirium in older patients undergoing major elective surgery: a longitudinal nested case-control study. Biol Psychiatry. 2017;15:81(2):145-53.

Gao Y, Duan J, Ji H, Lu W. Levels of S100 calcium binding protein B (S100B), neuron-specific enolase (NSE), and cycliphillin A (CypA) in the serum of patients with severe craniocerebral injury and multiple injuries combined with delirium transferred from the ICU and their prognostic value. Ann Palliat Med. 2021;10(3):3371-8.

Mietani K, Sumitani M, Ogata T, et al. Dysfunction of the blood-brain barrier in postoperative delirium patients, referring to the axonal damage biomarker phophorylated neurofilament heavy subunit. PLoS ONE. 2019;14(10):e0222721.

Ely EW, Inouye AJ, Bernard GR, et al. Delirium in mechanically ventilated patients, validity and reliability of the confusion assessment method for the Intensive Care Unit (CAM-ICU). JAMA. 2001;286(21):2703-10.

Kuswardhani T, Sugi Y. Factors related to the severity of delirium in the elderly patients with infection. Gerontol Geriatric Med. 2017;3(2):233372141773918.

Cerejeira J, Firmino H, Vaz-Serra A, Mukaetova-Ladinska EB. The neuroinflammatory hypothesis of delirium. Acta Neuropathol. 2010;119(6):737-54.

Tsuruta R, Oda Y. A clinical perspective of sepsis-associated delirium. J Intens Care. 2016;4(18):1-7.

Egberts A, Mattace-Raso FU. Increased neutrophil-lymphocyte ratio in delirium: a pilot study. Clin Intervent Aging. 2017;12:1115-21.

McNeil JB, Hughes CG, Girard T, et al. Plasma biomarkers of inflammation, coagulation, and brain injury as predictors of delirium duration in older hospitalized patients. PLoS ONE. 2019. https://doi.org/10.1371/journal.pone.0226412:1-10.

Loy D, Sroufe A, Pelt J, et al. Serum biomarkers for experimental acute spinal cord injury: rapid elevation of neuron-specific enolase and S-100beta. Neurosurgery. 2005;56: 391–7.

Hayakawa K, Okazaki R, Ishii K, et al. Phosphorylated neurofilament subunit NF-H as a biomarker for evaluating the severity of spinal cord injury patients, a pilot study. Spinal Cord. 2012;50(7):493-6.

Zhang Z, Pan L, Deng H, Ni H, Xu X. Prediction of delirium in critically ill patients with elevated c-reactive protein. J Crit Care. 2014;29:88-92.

Pol RA, van Leeuwen BL, Izaks GJ, et al. C-reactive protein predicts postoperative delirium following vascular surgery. Am Vasc Surg. 2014;28:1923-30.

Vasunilashorn SM, Dillon ST, Inouye SK, Ngo LH, Fong TG, Jones RN. High C-reactive protein predicts delirium incidence, duration, and feature severity after major non-cardiac surgery. J Am Geriatr Soc. 2017;65(8):e109-e116.

McGrane S, Girard TD, Thompson JL, et al. Procalcitonin and C-reactive protein levels at admission as predictors of duration of acute brain dysfunction in critically ill patients. Critical Care. 2011;15: (R78):1-8.


Full Text: PDF

Refbacks

  • There are currently no refbacks.