The association between C-reactive protein and delirium in 710 acute elderly hospital admissions
The association between C-reactive protein and delirium in 710 acute elderly hospital admissions
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DOI：
10.1017/s1041610213002433
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发表时间：
2014-05-01
影响因子：
7
通讯作者：
Sampson, E. L.
中科院分区：
文献类型：
--
作者：
Ritchie, C. W.;Newman, T. H.;Sampson, E. L.
背景：精神错乱是一种常见的神经精神综合征，预后不良。有证据支持神经炎性病因学，但炎症标记物C-反应蛋白(C-RP)的作用尚不清楚。我们调查了C-RP与妄想的关系及其严重程度以及与医学诊断的交互作用。方法：从现有的数据库(710名70岁以上的内科急诊住院患者)中，我们分析了包括C-RP水平、妄想(使用混淆评估方法)以及其他临床和人口统计学因素的数据。结果：C-RP升高与精神错乱有很强的相关性(t=5.09p<；0.001)，与其他潜在的危险因素无关(优势比OR=1.32(95%CI：1.10~1.58)p=0.003)。尽管OR为2.24(95%CI：0.92-5.45)，但在有心血管疾病、入院时感染或来自代谢组的人群中，C-RP与精神错乱的严重程度以及C-RP与精神错乱之间没有显著的关联。肌肉骨骼组的OR值为2.19(95%CI：1.19~4.02)。这在肌肉骨骼疾病入院的患者中最强，而在其他患者中则不是，这意味着C-RP参与了肌肉骨骼疾病中精神错乱的发生，但其他因素或过程可能在那些患有心血管疾病或感染的患者中更重要。
Background:Delirium is a common neuropsychiatric syndrome associated with poor outcomes. Evidence supports a neuroinflammatory etiology, but the role of the inflammatory marker C-reactive protein (C-RP) remains unclear. We investigated the relationship between C-RP and delirium and its severity as well as interaction with medical diagnosis.Methods:From an existing database (710 patients over 70 years old admitted to a Medical Acute Admissions Unit) we analyzed data which included C-RP levels, delirium (using the Confusion Assessment Method), and other clinical and demographic factors. Primary diagnoses were grouped (cardiovascular, musculoskeletal, infection, metabolic, and other).Results:There was a strong association between elevated C-RP and delirium (t = 5.09; p < 0.001), independent of other potential risk factors for delirium (odds ratio (OR) = 1.32 (95% CI: 1.10-1.58) p = 0.003). There was no significant association between C-RP and delirium severity, and between C-RP and delirium in the populations with cardiovascular disease, infection upon admission, or from the metabolic group despite an OR of 2.24 (95% CI: 0.92-5.45). There was an association in the musculoskeletal group (OR 2.19 (95% CI: 1.19-4.02)).Conclusions: There is an association between elevated C-RP and delirium. This is strongest in patients admitted with musculoskeletal disease but not in others, implying that C-RP is involved in the genesis of delirium in musculoskeletal disease, but that other factors or processes may be more important in those with cardiovascular disease or infection.