Procalcitonin and C-reactive protein levels at admission as predictors of duration of acute brain dysfunction in critically ill patients.
Procalcitonin and C-reactive protein levels at admission as predictors of duration of acute brain dysfunction in critically ill patients.
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DOI：
10.1186/cc10070
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发表时间：
2011
期刊：
影响因子：
--
通讯作者：
Pandharipande PP
中科院分区：
文献类型：
--
作者：
McGrane S;Girard TD;Thompson JL;Shintani AK;Woodworth A;Ely EW;Pandharipande PP
非重症监护病房（ICU）队列显示炎症性障碍和谵妄之间存在相关性，尽管这些关系尚未在危重患者中进行研究。本研究旨在探讨两种炎症生物标志物降钙素原和C反应蛋白（CRP）与通气患者急性脑功能障碍持续时间之间的关系。入选靶向镇静和减轻神经功能障碍（MENDS）试验的患者每天使用意识模糊评估方法-ICU评估谵妄。在入组后24小时内获得降钙素原和CRP的血浆水平。采用比例优势logistic回归分析分别检查降钙素原和CRP与谵妄/无昏迷天数的相关性，调整年龄、急性生理学和慢性健康评价（APACHE）II的急性生理学评分（APS）、镇静组（右美托咪定vs劳拉西泮）和脓毒症。次要分析检查了这些标志物与其他器官功能障碍和28天生存率的相关性。87例患者纳入本分析。患者的中位年龄为60岁，APACHE II评分为28分; 68%的患者在入院后48小时内发生脓毒症。降钙素原水平越高，谵妄/无昏迷天数越少[比值比（OR），0.5; 95%置信区间（CI），0.3 - 1.0; P = 0.04]，而CRP水平越高，谵妄/无昏迷天数越少（OR，0.6; 95% CI，0.3 - 1.1; P = 0.08）。无论是否存在败血症，都发现了类似的关系。降钙素原或CRP与28天生存率之间无相关性（分别为P = 0.40和0.16）。在我们的初步研究中，高基线炎症生物标志物可预测急性脑功能障碍的延长期，表明炎症是危重病期间谵妄和昏迷的病理生理学的重要机制，无论患者是否患有败血症。
Non-intensive care unit (ICU) cohorts have shown an association between inflammatory disturbances and delirium, though these relationships have not been studied in critically ill patients. This study sought to investigate the relationship between two inflammatory biomarkers, procalcitonin and C-reactive protein (CRP), and duration of acute brain dysfunction in ventilated patients. Patients enrolled in the Maximizing Efficacy of Targeted Sedation and Reducing Neurological Dysfunction (MENDS) trial were assessed daily for delirium using the Confusion Assessment Method-ICU. Plasma levels of procalcitonin and CRP were obtained within 24 hours of enrollment. Proportional odds logistic regression was used to examine the association between procalcitonin and CRP separately with delirium/coma-free days, adjusting for age, acute physiology score (APS) of the Acute Physiology And Chronic Health Evaluation (APACHE) II, sedation group (dexmedetomidine vs. lorazepam), and sepsis. Secondary analyses examined the association of these markers with other organ dysfunctions and 28-day survival. Eighty-seven patients were included in this analysis. The median age of the patients was 60 years with APACHE II scores of 28; 68% had sepsis within 48 hours of admission. Higher levels of procalcitonin were associated with fewer delirium/coma-free days [odds ratio (OR), 0.5; 95% confidence interval (CI), 0.3 to 1.0; P = 0.04], whereas higher CRP levels showed trends towards fewer delirium/coma-free days (OR, 0.6; 95% CI, 0.3 to 1.1; P = 0.08). Similar relationships were found regardless of the presence of sepsis. No associations were found between procalcitonin or CRP with 28-day survival (P = 0.40 and 0.16, respectively). In our pilot study, high baseline inflammatory biomarkers predicted prolonged periods of acute brain dysfunction, implicating inflammation as an important mechanism in the pathophysiology of delirium and coma during critical illness, irrespective of whether patients had sepsis or not.
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影响因子：
158.5
作者：
Inouye, SK;Bogardus, ST;Cooney, LW
通讯作者：
Cooney, LW
del妄作为重症疾病幸存者长期认知障碍的预测指标。
影响因子：
8.8
作者：
Girard TD;Jackson JC;Pandharipande PP;Pun BT;Thompson JL;Shintani AK;Gordon SM;Canonico AE;Dittus RS;Bernard GR;Ely EW
通讯作者：
Ely EW
影响因子：
8.8
作者：
Ely, EW;Margolin, R;Inouye, SK
通讯作者：
Inouye, SK
影响因子：
3.5
作者：
Beloosesky, Y;Grinblat, J;Hendel, D
通讯作者：
Hendel, D
影响因子：
6.9
作者：
JORM, AF
通讯作者：
JORM, AF