Preprint Article Version 1 Preserved in Portico This version is not peer-reviewed

Biomarkers and Clinical Features of Delirium in Elderly Individuals With Hip Fracture Surgery.

Version 1 : Received: 30 December 2020 / Approved: 4 January 2021 / Online: 4 January 2021 (11:26:34 CET)

How to cite: Thisayakorn, P. Biomarkers and Clinical Features of Delirium in Elderly Individuals With Hip Fracture Surgery.. Preprints 2021, 2021010014 (doi: 10.20944/preprints202101.0014.v1). Thisayakorn, P. Biomarkers and Clinical Features of Delirium in Elderly Individuals With Hip Fracture Surgery.. Preprints 2021, 2021010014 (doi: 10.20944/preprints202101.0014.v1).

Abstract

Background: Post-operative delirium in elderly with hip fracture is associated with various adverse clinical outcomes. Nevertheless, the pathophysiological processes underpinning delirium have remained elusive. The aim of this study is to explore the associations between delirium and its features and immune-inflammatory and blood gas biomarkers.Methods: In this prospective study we examined 65 patients who underwent a hip fracture surgery and assessed the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU), Richmond Agitation-Sedation Scale (RASS), and Delirium Rating Scale Revised-98 (DRS-R-98) before and during 4 days after the surgery. Complete Blood Count (CBC) and venous blood gas markers were obtained at the same time points.Results: Delirium was observed in 19 patients and was accompanied by significantly increased pO2, number of white blood cells, neutrophil percentage, and neutrophil/lymphocyte ratio, and lower mean platelet volume (MPV) (after adjusting for age, central nervous system (CNS) disease, blood loss during surgery, sleep disorders, and body mass index. The severity of delirium was associated with lowered number of platelets and MPV. Psychomotor disorders were associated with lower bicarbonate levels. The requirement of physical restraint of the patients was predicted by increased percentages of neutrophils and lymphocytes. Prior CNS disease was together with these biomarkers a significant predictor of delirium and severity of delirium. Conclusion: Delirium and psychomotor disorders following hip fracture and surgery may be caused by immune-inflammatory and oxidative stress pathways probably attributable to an aseptic inflammatory process. Oxygen administration may aggravate these pathways.

Subject Areas

delirium; inflammation; neuro-immune; biomarkers; oxidative stress

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