Raised IL-2 and TNF-α concentrations are associated with postoperative delirium in patients undergoing coronary-artery bypass graft surgery
Raised IL-2 and TNF-α concentrations are associated with postoperative delirium in patients undergoing coronary-artery bypass graft surgery
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DOI：
10.1017/s1041610213002378
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发表时间：
2014-05-01
影响因子：
7
通讯作者：
Jaszewski, Ryszard
中科院分区：
文献类型：
--
作者：
Kazmierski, Jakub;Banys, Andrzej;Jaszewski, Ryszard
背景：关于术后谵妄发病机制的知识基础是有限的。本研究的主要目的是调查在接受心肺转流（CPB）的冠状动脉旁路移植术（CABG）手术的患者中，IL-2和TNF-α水平升高是否与谵妄相关。第二个目的是建立是否有任何关联之间的细胞因子水平升高和谵妄是相关的手术和麻醉程序或介导的预先存在的条件与细胞因子水平升高，如重度抑郁症（MDD），认知功能障碍，或aging.Methods：患者进行了检查和筛选MDD和认知功能障碍一天术前，使用迷你国际神经精神访谈和蒙特利尔认知评估和连线测试部分B。结果：术后谵妄筛查阳性率为36%（41/113）。多变量logistic回归分析显示，促炎细胞因子浓度升高与谵妄相关，并与年龄增长、参与者术前认知功能下降和CPB持续时间相关。根据受试者操作特征分析，IL-2和TNF-α浓度预测谵妄发展的最佳截止值分别为907.5 U/ml和10.95 pg/ml.Conclusions：本研究表明，提高术后细胞因子浓度与CABG手术后谵妄相关。术后监测促炎性标志物结合定期监测可能有助于早期发现该患者组的术后谵妄。
Background:The knowledge base regarding the pathogenesis of postoperative delirium is limited. The primary aim of this study is to investigate whether increased levels of IL-2 and TNF-alpha are associated with delirium in patients who underwent coronary-artery bypass graft (CABG) surgery with cardiopulmonary bypass (CPB). The secondary aim is to establish whether any association between raised cytokine levels and delirium is related to surgical and anesthetic procedures or mediated by pre-existing conditions associated with raised cytokine levels, such as major depressive disorder (MDD), cognitive impairment, or aging.Methods:Patients were examined and screened for MDD and cognitive impairment one day preoperatively, using the Mini International Neuropsychiatric Interview and The Montreal Cognitive Assessment and Trail Making Test Part B. Blood samples were collected postoperatively for cytokine levels.Results:Postoperative delirium screening was found positive in 36% (41 of 113) of patients. A multivariate logistic regression revealed that an increased concentration of pro-inflammatory cytokines is associated with delirium, and related to advancing age, preoperative cognitive decline of participants, and duration of CPB. According to receiver operating characteristic analysis, the most optimal cut-off for IL-2 and TNF-alpha concentrations in predicting the development of delirium were 907.5 U/ml and 10.95 pg/ml, respectively.Conclusions:The present study suggests that raised postoperative cytokine concentrations are associated with delirium after CABG surgery. Postoperative monitoring of pro-inflammatory markers combined with regular surveillance may be helpful in the early detection of postoperative delirium in this patient group.