Unraveling the Relationship Between Delirium, Brain Damage, and Subsequent Cognitive Decline in a Cohort of Individuals Undergoing Surgery for Hip Fracture
Unraveling the Relationship Between Delirium, Brain Damage, and Subsequent Cognitive Decline in a Cohort of Individuals Undergoing Surgery for Hip Fracture
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DOI：
10.1111/jgs.14470
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发表时间：
2017-01-01
影响因子：
6.3
通讯作者：
de Rooij, Sophia E.
中科院分区：
文献类型：
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作者：
Beishuizen, Sara J. E.;Scholtens, Rikie M.;de Rooij, Sophia E.
目的评估血清S100B水平(脑损伤的标志物)、精神错乱和随后的认知衰退之间的关系。设计一项多中心随机对照试验的子研究。设置在两所教学医院的外科、骨科和创伤外科病房。参与者年龄65岁及以上(范围65-102)因髋部骨折手术入院(N=385)。测量：在住院期间，每天评估是否存在精神错乱。重复采集血清标本进行S100B检测。出院12个月后，评估认知功能减退和死亡率。认知功能减退是指被调查者在入院至出院12个月期间认知功能减退问卷评分增加1个标准差或简明精神状态量表评分下降3分以上。结果226例(58.7%)患者存在病前认知功能障碍，127例(33.0%)出现围手术期精神障碍。多变量分析显示，年龄较大和感染的存在，而不是精神错乱，与较高的S100B水平相关。手术后的水平也比手术前高。在围手术期的患者中，58.6%的患者出现认知功能下降或死亡，只有年龄是一个危险因素；36.5%的非围手术期患者出现认知功能下降或次年死亡，较高的S100B、病前认知功能障碍和年龄较大是危险因素。结论在一组老年髋部骨折患者中，未发现血清S100B水平与精神分裂症的发生相关。只有在没有围手术期精神错乱的参与者中，S100B才与髋部骨折后第一年的认知能力下降或死亡有关。S100B作为与精神错乱相关的脑损伤的生物标志物的价值似乎是有限的。
ObjectivesTo assess the association between serum S100B levels (a marker of brain damage), delirium, and subsequent cognitive decline.DesignSubstudy of a multicenter randomized controlled trial.SettingSurgical, orthopedic, and trauma surgery wards of two teaching hospitals.ParticipantsIndividuals aged 65 and older (range 65-102) admitted for hip fracture surgery (N = 385).MeasurementsDuring hospitalization, presence of delirium was assessed daily. S100B was assayed in repeated serum samples. Twelve months after discharge, cognitive decline and mortality were evaluated. Cognitive decline was defined as an increase in Informant Questionnaire on Cognitive Decline Short Form score of 1 standard deviation or more or a decrease in Mini Mental State Examination score of 3 points or more between admission and 12 months after discharge.ResultsPremorbid cognitive impairment was present in 226 (58.7%) participants, and 127 (33.0%) experienced perioperative delirium. Multivariable analysis showed that older age and presence of infection, but not of delirium, were associated with higher S100B levels. Levels were also higher after surgery than before. Of participants with perioperative delirium, 58.6% experienced cognitive decline or death, and only age was a risk factor; 36.5% of participants without perioperative delirium experienced cognitive decline or death in the following year, and higher S100B, premorbid cognitive impairment, and older age were risk factors.ConclusionIn a cohort of older adults with hip fracture, no association was found between serum S100B levels and occurrence of delirium. S100B was associated with cognitive decline or death in the first year after hip fracture only in participants without perioperative delirium. S100B seems to be of limited value as a biomarker of brain damage associated with delirium.