Cytokines and IGF-I in delirious and non-delirious acutely ill older medical inpatients

Adamis, Dimitrios; Lunn, Mary; Martin, Finbarr C.; Treloar, Adrian; Gregson, N. A.; Hamilton, Gillian; Macdonald, Alastair

doi:10.1093/ageing/afp014

Cited by 81 publications

(87 citation statements)

References 25 publications

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“…Despite the theoretical potential role of TNF-a in delirium associated with cancer, abnormalities in this cytokine have not been found in other conditions associated with delirium. 12,37 Conversely, our results could be explained by an ephemeral increase in TNF-a in the blood, which could not exactly reflect its central nervous system levels. Increased TNF-a could last a few hours in the blood and this transitory rise would be sufficient to activate the neuroinflammatory cascade.…”

Section: Discussioncontrasting

confidence: 56%

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Association of serum brain-derived neurotrophic factor (BDNF) and tumor necrosis factor-alpha (TNF-α) with diagnosis of delirium in oncology inpatients

Brum

Stertz

Borba

et al. 2015

Braz. J. Psychiatry

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Objective: To evaluate brain-derived neurotrophic factor (BDNF) and tumor necrosis factor-a (TNF-a) blood levels as disease biomarkers of delirium in oncology inpatients. Methods: Seventeen oncology inpatients with delirium, 28 oncology inpatients without delirium, and 25 non-oncology controls (caregivers) were consecutively recruited from a Brazilian cancer center. This sample was matched by age, sex, and education level. The Confusion Assessment Method, the Mini-Mental State Examination, and the Digit Span Test were administered to ascertain delirium diagnosis. BDNF and TNF-a levels were measured by the Sandwich-ELISA method and flow cytometry, respectively. Blood samples were collected immediately after clinical evaluation. Results: Oncology inpatients (with and without delirium) showed significantly lower BDNF levels compared with non-oncology controls (F = 13.830; p = 0.001). TNF-a levels did not differ between the three groups. Conclusion: A cross-sectional relationship of BDNF and TNF-a blood levels with delirium in oncology inpatients was not demonstrated. The association between cancer and reduced serum BDNF levels may be mediated by confounding factors.

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Section: Discussioncontrasting

confidence: 56%

“…Finally, there is neuronal and synaptic dysfunction leading to delirium. [2][3][4][5][6] The high prevalence of delirium in sepsis, 7 surgery, 8,9 and treatment of cancer with interleukin and interferon 10,11 and the high levels of inflammatory markers observed in many etiologies of delirium 8,9,12,13 support this theory.…”

Section: Introductionmentioning

confidence: 96%

Association of serum brain-derived neurotrophic factor (BDNF) and tumor necrosis factor-alpha (TNF-α) with diagnosis of delirium in oncology inpatients

Brum

Stertz

Borba

et al. 2015

Braz. J. Psychiatry

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“…Activation of the immune system, oxidative stress, loss of neuroprotection and disturbances in cerebral neurotransmitter systems may all contribute to a delirium [6,7,8,9]. During immune activation, monocytes and macrophages are stimulated to produce neopterin in response to the proinflammatory cytokine interferon-gamma [10,11].…”

Section: Introductionmentioning

confidence: 99%

Neopterin: A Potential Biomarker for Delirium in Elderly Patients

Egberts¹,

Wijnbeld²,

Fekkes³

et al. 2014

Dement Geriatr Cogn Disord

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Background/Aims: The diagnosis of delirium is not supported by specific biomarkers. In a previous study, high neopterin levels were found in patients with a postoperative delirium. In the present study, we investigated levels of neopterin, interleukin-6 (IL-6) and insulin-like growth factor-1 (IGF-1) in acutely ill admitted elderly patients with and without a delirium. Methods: Plasma/serum levels ofneopterin, IL-6 and IGF-1 were determined in patients aged ≥65 years admitted to the wards of Internal Medicine and Geriatrics. Differences in biomarker levels between patients with and without a delirium were investigated by the analysis of variance in models adjusted for age, gender, comorbidities and eGFR (when appropriate). Results: Eighty-six patients were included; 23 of them with a delirium. In adjusted models, higher mean levels of neopterin (70.5 vs. 45.9 nmol/l, p = 0.009) and IL-6 (43.1 vs. 18.5 pg/ml, p = 0.034) and lower mean levels of IGF-1 (6.3 vs. 9.3 nmol/l, p = 0.007) were found in patients with a delirium compared to those without. Conclusions: The findings of this study suggest that neopterin might be a potential biomarker for delirium which, through oxidative stress and activation of the immune system, may play a role in the pathophysiology of delirium. © 2014 S. Karger AG, Basel

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“…Entretanto, no estudo de Pfister et al (2008) o fluxo sanguíneo cerebral testado com Doppler transcraniano da artéria cerebral média não diferiu significativamente entre os pacientes estudados, sugerindo um possível mecanismo microvascular sem alteração visível ao estudo doppler. Alterações no eixo hipotálamo-hipófise-adrenal, como outra explicação fisiopatológica, evidenciada por níveis persistentemente altos de cortisol, estão associadas a estresse e delirium em diversos estudos já anteriormente citados (PFISTER et al, 2008;PLASCHKE et al, 2010) Em estudo de Adamis et al (2009) a citocina anti-inflamatória IL-RA e o fator de crescimento insulina-like IGF-1, foram evidenciados como possíveis fatores neuroprotetores, pois o menor nível sérico de ambos foi associado significativamente ao delirium.…”

Section: Resultsunclassified

Fisiopatologia imuno-inflamatória do delirium: revisão da literatura

Chalhub

Quarantini²

2011

cmbio

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RESUMOO delirium, marcador de disfunção orgânica cerebral, está presente de maneira frequente na prática clínica e tem importância prognóstica aumentando morbi-mortalidade em diversos cenários clínicos e cirúrgicos de pacientes internados em unidades de terapia intensiva. Objetivo: Elucidar quais as principais alterações imuno-inflamatórias relacionadas ao delirium através de uma revisão não sistemática da literatura. Metodologia: Busca no banco de dados PubMed, utilizando os seguintes unitermos: "delirium", "inflammation", e "cytokines", nos últimos 5 anos, publicados em idioma inglês. Sumarizamos as evidências encontradas relacionadas a fisiopatologia imuno-inflamatória do delirium. Resultado: Mecanismos imunoinflamatórios têm sido propostos para elucidação fisiopatológica do delirium, dentre eles o papel de citocinas pró e antiinflamatórias, a ativação microglial, a quebra da barreira hemato-encefálica e o desequilíbrio do eixo hipotálamo-hipófise-adrenal. Conclusão: No estudo do delirium e de sua fisiopatologia, os mecanismos imuno-inflamatórios parecem ter papel importante na sua gênese, contudo, mais estudos são necessários para elucidar melhor esta relação. Palavras-chave: Delirium. Inflamação. Citocinas. ABSTRACTDelirium is a severity marker of brain dysfunction. It is prevalent among clinical and surgical patients, with a high impact on morbidity and mortality in distinct scenarios in intensive care patients. Objective: To elucidate the most important findings about the pathophysiology of immune-inflammatory pathways of delirium in the literature. Methods: Search in the PubMed using the terms: "delirium", "inflammation" and "cytokines" in the last 5 years, in Engli sh idiom. Results: Many immune-inflammatory pathways have been proposed to explain delirium. Some of the main physiopat hology mechanisms are: the cytokines, the breakdown of the brain-blood barrier, and a misbalance of the hypothalamus-pituitaryadrenal axis. Conclusion: In the study of delirium and its pathophysiology it seems that the immune-inflammatory pathways play a critical role in its genesis, but more studies are needed to better elucidate this relationship.

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Cytokines and IGF-I in delirious and non-delirious acutely ill older medical inpatients

Cited by 81 publications

References 25 publications

Association of serum brain-derived neurotrophic factor (BDNF) and tumor necrosis factor-alpha (TNF-α) with diagnosis of delirium in oncology inpatients

Association of serum brain-derived neurotrophic factor (BDNF) and tumor necrosis factor-alpha (TNF-α) with diagnosis of delirium in oncology inpatients

Neopterin: A Potential Biomarker for Delirium in Elderly Patients

Fisiopatologia imuno-inflamatória do delirium: revisão da literatura

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