High Preoperative Plasma Neopterin Predicts Delirium After Cardiac Surgery in Older Adults

Osse, Robert Jan; Fekkes, Durk; Tulen, Joke H.M.; Wierdsma, André I.; Bogers, Ad J.J.C.; Mast, Rose C. van der; Hengeveld, Michiel W.

doi:10.1111/j.1532-5415.2011.03885.x

Cited by 53 publications

(61 citation statements)

References 34 publications

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“…The effect of renal function on neopterin levels has probably not influenced our results, since neopterin levels were adjusted for eGFR. Our finding of increased neopterin levels in elderly patients with a delirium is in agreement with the elevated neopterin levels that have previously been found by Osse et al [6] in patients with a postoperative delirium. …”

Section: Discussionsupporting

confidence: 82%

“…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%

“…During immune activation, monocytes and macrophages are stimulated to produce neopterin in response to the proinflammatory cytokine interferon-gamma [10,11]. Increased neopterin production has been associated with neurodegenerative disorders like Alzheimer's disease [12] and Huntington's disease [13], but also delirium after cardiac surgery [6]. To the best of our knowledge, the potential role of neopterin in delirium has never been investigated in elderly patients admitted due to acute pathology.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionsupporting

confidence: 82%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Neopterin: A Potential Biomarker for Delirium in Elderly Patients

Egberts¹,

Wijnbeld²,

Fekkes³

et al. 2014

Dement Geriatr Cogn Disord

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“…Además, está demostrado que en respuestas a eventos traumáticos o sistémicos, el sistema inflamatorio se activa, causando que monocitos y macrófagos produzcan neopterina, citocinas y especies reactivas de oxígeno, todos los cuales pueden ser encontrados en el (16,17,18) plasma, la orina y el líquido cefalorraquídeo de pacientes con delirium .…”

Section: Hipótesis Del Estrés Oxidativounclassified

Delirium: an update for internists and psychiatrists

Torales

Barrios

Armoa

2017

Rev. virtual Soc. Parag. Med. Int

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RESUMENA lo largo del tiempo, al delirium se lo ha conocido por diversos nombres: falla cerebral aguda, síndrome cerebral orgánico agudo, síndrome confusional o psicosis postquirúrgica. No obstante, el término preferido en la actualidad es delirium (de latín delirare, que significa "arar fuera del surco"). El delirium, como síndrome, es un conjunto de signos y síntomas de inicio agudo caracterizado por deterioro cognitivo fluctuante, con enturbiamiento de la conciencia y capacidad disminuida de mantener y cambiar la atención de un punto a otro.Numerosos estudios han demostrado que los pacientes que desarrollan delirium tienen un riesgo aumentado de resultados adversos tanto durante la hospitalización como tras el alta. Este riesgo es independiente de cualquier comorbilidad existente, de la severidad de la enfermedad, la edad u otras variables asociadas. Asimismo, el delirium está asociado a un incremento en la mortalidad, aumento del tiempo de hospitalización y desarrollo de disfunciones cognitivas posteriores al alta.Este artículo de revisión presenta una actualización acerca de la fisiopatología del delirium, de las herramientas de reconocimiento del cuadro y de su tratamiento. Todas estas informaciones resultan útiles en el manejo diario de este tipo de pacientes, tanto por médicos internistas como por médicos psiquiatras. Palabras claves:ABSTRACT Over time, delirium has been known by several names: acute brain failure, acute organic brain syndrome, confusional syndrome, or post-surgical psychosis. However, the currently preferred term is delirium (from the Latin term delirare, which means "to go out of the furrow"). Delirium, as a syndrome, is a set of signs and symptoms of acute onset characterized by fluctuating cognitive impairment, clouding of consciousness and diminished ability to maintain and shift attention from one point to another. Numerous studies have shown that patients who develop delirium have an increased risk of adverse outcomes both during hospitalization and after discharge. This risk is independent of any existing comorbidity, severity of disease, age or other associated variables. Likewise, delirium is associated with an increase in mortality, delirio, trastornos neurocognitivos, síndrome confusional, delirio -fisiopatología, delirio -tratamiento farmacológico

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“…94, 96 Despite the identification of these risk factors, the pathophysiology of POD remains unclear. Numerous biomarkers have been correlated with delirium, 97 including inflammatory markers, 98 markers of brain injury, 99 and serum creatinine. 94 Neuroimaging findings can also correlate with delirium.…”

Section: Introductionmentioning

confidence: 99%

Neurological complications of cardiac surgery

McDonagh¹,

Berger²,

Mathew³

et al. 2014

The Lancet Neurology

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The consultant neurologist is frequently called upon to assess patients with neurologic complications from cardiac surgery. Some complications mandate acute intervention while others require longer term observation and management. The body of literature pertaining to these complications is massive and ever-changing. Similarly, technological advancements in surgical intervention and modifications in surgical technique create new avenues for neurologic injury. Rapid precise neurologic assessment is paramount and rests on a solid understanding of the evidence base and procedural variables. This clinically focused review is intended to describe the current state of the field for the consultant neurologist.

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High Preoperative Plasma Neopterin Predicts Delirium After Cardiac Surgery in Older Adults

Cited by 53 publications

References 34 publications

Neopterin: A Potential Biomarker for Delirium in Elderly Patients

Neopterin: A Potential Biomarker for Delirium in Elderly Patients

Delirium: an update for internists and psychiatrists

Neurological complications of cardiac surgery

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