Neutrophil-lymphocyte Ratio as a Predictor of Delirium in Older Hospitalized Patients: A Prospective Cohort Study

Abstract

Background: Delirium is a common neuropsychiatric syndrome in older hospitalized patients. Previous studies have suggested that inflammation and oxidative stress contribute to the pathophysiology of delirium. However, it remains unclear whether neutrophil-lymphocyte ratio (NLR), an indicator of systematic inflammation, is associated with delirium. This study aimed to investigate the value of NLR as a predictor of delirium among older hospitalized patients.Methods: We conducted a prospective study of 740 hospitalized patients aged 70 years at the West China Hospital of Sichuan University. Neutrophil and lymphocyte counts were collected within 24 hours after hospital admission. Delirium was assessed on admission and every 48 hours thereafter. We used the Receiver operating characteristic analysis to assess the ability of the NLR for predicting delirium. The optimal cut-point value of the NLR was determined based on the highest Youden index (sensitivity + specificity - 1). Patients were categorized according to the cut-point value and quartiles of NLR, respectively. We then used logistic regression to identify the unadjusted and adjusted associations between NLR as a categorical variable and delirium. Results: The optimal cut-point value of NLR for predicting delirium was 3.626 (sensitivity: 75.2%; specificity: 63.4%; Youden index: 0.386). The incidence of delirium was significantly higher in patients with NLR >3.626 than NLR ≤3.626 (24.5% vs 5.8%; P<0.001). Significantly fewer patients in the first quartile of NLR experienced delirium than in the 3rd (4.3% vs 20.0%; P<0.001) and 4th quartiles of NLR (4.3% vs 24.9%; P<0.001). Multivariable logistic regression analysis showed that NLR was independently associated with delirium.Conclusions: NLR is a simple and practical marker that can predict the development of delirium in older hospitalized patients.

Gambaran Dan Karakteristik Pasien Delirium Pada Cedera Otak Di Rumah Sakit Umum Daerah Provinsi Nusa Tenggara Barat

“…18,19 Selain itu, penelitian lain yang berkaitan dengan komponen leukosit menyatakan bahwa adanya peningkatan NLR (Neutrophil-Lymphocyte Ratio) (NLR >3,626) didapatkan banyak pada pasien delirum. 20 Sedangkan untuk kadar glukosa, didapatkan dalam penelitian ini bahwa pasien dengan kadar glukosa yang normal lebih banyak dibandingkan pasien yang hiperglikemia. Hal ini dikarenakan frekuensi cedera otak pada penelitian ini yang terbanyak adalah derajat sedang.…”