Association between Serum IGF-I levels and Postoperative Delirium in Elderly Subjects Undergoing Elective Knee Arthroplasty

Yen, Timothy; Allen, John C.; Rivelli, Sarah K.; Patterson, Stephanie C.; Metcalf, Maynard M.; Flink, Benjamin J.; Mirrakhimov, Aibek E.; Lagoo, Sandhya A.; Vail, Thomas P.; Young, Christopher C.; Moon, Richard E.; Trzepacz, Paula T.; Kwatra, Madan M.

doi:10.1038/srep20736

Cited by 15 publications

(17 citation statements)

References 51 publications

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“…First of all different populations were studied. Some studies include populations with pre-existing dementia ( e.g ., the present study) while others excluded them[ 41 , 42 ]. A second reason perhaps is the setting where the study is conducted and the sample.…”

Section: Discussionmentioning

confidence: 99%

Delirium, insulin-like growth factor I, growth hormone in older inpatients

Adamis¹,

Coada²,

Eikelenboom³

et al. 2020

WJP

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BACKGROUND Delirium is a common disorder in elderly medical inpatients with serious adverse outcomes and is characterized by sudden onset, disturbance in attention, awareness, consciousness and cognition, and often with behavioural disturbances. Central to understanding delirium, is understanding mechanisms by which body and brain wellbeing are linked and in particular how brain responses to bodily homeostatic stress is mediated. A number of studies have investigated the relationship between insulin-like growth factor I (IGF-I) and delirium in medically ill hospitalised patients with conflicting results. However, none have investigated growth hormone (GH) which is related to IGF-I via negative feedback. AIM To investigate the relationship between serum levels of IGF-I and GH, and the occurrence of delirium. METHODS Prospective, longitudinal, observational study. Consecutive elderly inpatients (aged 70+), were assessed twice weekly with Montreal cognitive assessment (MoCA), Confusion assessment method (CAM), Acute Physiology and Chronic Health Evaluation II. Delirium was defined using CAM. Previous history of dementia was evaluated with the Informant Questionnaire on Cognitive Decline in the Elderly. IGF-I and GH levels were estimated with the ELISA method. Generalized estimating equations (GEE) model was applied for the first five assessments to analyze those longitudinal data. RESULTS The sample consisted of 198 participants (mean age 80.63 ± 6.81; range 70-97). Of these 92 (46.5%) were females. Eighty six (43.4%) were identified with a history of dementia. Incident or prevalent delirium during hospitalisation was identified with CAM in 40 participants (20.2%). Evaluation of missing values with Little's MCAR test indicated that they were missing completely at random (MCAR χ 2 = 12.24, u : 9, P = 0.20). Using GEE for the analysis we found that low MoCA scores, low levels of IGF-I and high levels of GH were significantly associated with any delirium (prevalence, incident, or fluctuating , during the study period (Wald χ 2 = 12.231; u : 1, P < 0.001, Wald χ 2 = 7.196, u : 1, P = 0.007, Wald χ 2 = 6.210; : u: 1, P = 0.013 respectively). CONCLUSION The results show that low levels of IGF-I, high levels of GH and low scores in cognition are independently associated with the occurrence of any delirium during the hospitalisation of medically ill older people. The results of the study supports the hypothesis that deficits in the immunoreactivity of the brain (low cerebral reserve) may be...

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Section: Discussionmentioning

confidence: 99%

Delirium, insulin-like growth factor I, growth hormone in older inpatients

Adamis¹,

Coada²,

Eikelenboom³

et al. 2020

WJP

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“…POD assessment was performed using the Delirium Observation Screening Scale (DOSS) [7] Confusion Assessment Method (CAM) [8–36] or CAM-ICU [13, 24, 36], Delirium Rating Scale (DRS) [9, 15, 31, 37], Diagnostic and Statistical Manual of Mental Disorders (IV) [DSM IV] [7, 14, 36–39], or validated chart review [10, 21, 24, 34, 35]. Most studies assessed POD from the day of surgery, three studies assessed POD from post-operative day 2 onwards [8, 9, 15], and 6 studies did not specify the time of POD assessment [7, 23, 35–37, 40]. In studies which assessed delirium on the day of surgery, none mentioned whether they included PACU delirium or distinguished between emergence agitation or POD.…”

Section: Resultsmentioning

confidence: 99%

“…The 34 studies included data from 4424 patients. Nineteen studies described pre-operative serum biomarker tests [8, 10, 12–25, 37, 38, 41], 10 described CSF biomarker tests [7, 9, 11, 26–33] and 5 described imaging tests [34–36, 40, 41]. Four studies investigated several different biomarkers [9, 11, 14, 17].…”

Section: Resultsmentioning

confidence: 99%

Pre-operative biomarkers and imaging tests as predictors of post-operative delirium in non-cardiac surgical patients: a systematic review

Ayob

Lam

et al. 2019

BMC Anesthesiol

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Background Post-operative delirium (POD) is a common post-operative complication in elderly individuals and imposes a significant health and financial burden. Identifying predictive biomarkers may help understand the pathophysiology of POD. Our objective is to summarize the evidence of pre-operative biomarkers and imaging tests to predict POD in patients undergoing non-cardiac surgery. Methods A systematic search of English language articles in MEDLINE, EMBASE, Cochrane Database, PsychINFO, PubMed and ClinicalTrials. Gov up to January 2018 was performed. Studies that used biomarkers or imaging tests to predict POD and a validated POD assessment tool were included. Animal studies, paediatric, cardiac and intracranial surgery were excluded. Risk of bias was assessed using the Quality In Prognosis Study tool. Results Thirty-four prospective cohort studies involving 4424 patients were included. Nineteen studies described serum tests [Interleukin-6, Insulin-like Growth Factor 1, C-Reactive Protein (CRP), cholinesterases, apolipoprotein-E genotype, leptin, hypovitaminosis, hypoalbuminaemia, gamma-amino butyric acid], 10 described cerebral-spinal fluid tests (monoamine precursor, melatonin, acute phase proteins, S100B and neurofibrillary tangles), and 5 described imaging tests. Two studies had high risk of bias due to unclear outcome measurement and study participation. CRP was significantly associated with POD in 5 studies. Other biomarkers were either examined by only a single study or two or more studies with conflicting results. Conclusion CRP is the most promising biomarker associated with POD. However, we are still in the early stages in identifying biomarkers and imaging tests that may further understanding of the pathophysiology of POD. Electronic supplementary material The online version of this article (10.1186/s12871-019-0693-y) contains supplementary material, which is available to authorized users.

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“…From the bivariate analyses, demographic variables with a p value of < 0.15 were included in the adjusted proportional odds regression [ 50 , 51 ]. The covariates in the proportional odds model were pregravid BMI status (combined as underweight/normal (UN) or overweight/obese (OWOB)), being up-to-date with infant vaccinations, parity, and maternal age.…”

Section: Methodsmentioning

confidence: 99%

Associations between gestational weight gain and rate of infancy weight gain in Hawai‘i and Puerto Rico WIC participants

et al. 2018

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BackgroundExcessive gestational weight gain and rapid infancy weight gain (RIWG) are associated with increased susceptibility to childhood obesity. Since low-income and minority children are particularly at risk, investigation of the associations between gestational weight gain and rate of infancy weight gain may inform childhood obesity prevention. This study investigated the associations between gestational weight gain and rate of infancy weight gain during the first four to six months postpartum in participants from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Hawai‘i and Puerto Rico.MethodsThis was a cross-sectional secondary data analysis from a text message-based intervention in WIC participants in Hawai‘i and Puerto Rico. The analysis included 80 mother/infant pairs from the control group who completed the follow-up visit when infants were four to six months old. Maternal weight, height, and gestational weight gain were self-reported. Infant weight was measured at baseline and follow-up. A proportional odds model was used to investigate the association between gestational weight gain and infancy weight gain rate (rapid or extremely rapid, on-track, or slow), adjusting for maternal age, pregravid body mass index (BMI) status, parity, and being up-to-date with infant vaccinations.ResultsIn comparison to recommended gestational weight gain, excessive and inadequate (under the recommended amount) gestational weight gain was associated with 77% decreased (adjusted odds ratio [AOR] = 0.23; 95% confidence interval [CI] = 0.08, 0.70; p = 0.01) and 71% decreased (AOR = 0.29; 95% CI = 0.09, 0.94; p = 0.04) odds of RIWG versus on-track or slow infant weight gain, respectively. In comparison to women with one child, women with two children (AOR = 0.31; 95% CI = 0.11, 0.87; p = 0.03) or three or four children (AOR = 0.24; 95% CI = 0.07, 0.88; p = 0.03) had significantly lower odds of RIWG versus on-track or slow infancy weight gain.ConclusionsWomen with excessive or inadequate gestational weight gain had lower proportional odds of RIWG and were more likely to have slower infant weight gain than women who gained the recommended amount of weight.Trial registrationClinicalTrials.gov Identifier; NCT02903186; September 16, 2016.

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Association between Serum IGF-I levels and Postoperative Delirium in Elderly Subjects Undergoing Elective Knee Arthroplasty

Cited by 15 publications

References 51 publications

Delirium, insulin-like growth factor I, growth hormone in older inpatients

Delirium, insulin-like growth factor I, growth hormone in older inpatients

Pre-operative biomarkers and imaging tests as predictors of post-operative delirium in non-cardiac surgical patients: a systematic review

Associations between gestational weight gain and rate of infancy weight gain in Hawai‘i and Puerto Rico WIC participants

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