Pre-Operative, High-IL-6 Blood Level is a Risk Factor of Post-Operative Delirium Onset in Old Patients.
Pre-Operative, High-IL-6 Blood Level is a Risk Factor of Post-Operative Delirium Onset in Old Patients.
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DOI：
10.3389/fendo.2014.00173
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发表时间：
2014
影响因子：
5.2
通讯作者：
Franceschi C
中科院分区：
文献类型：
--
作者：
Capri M;Yani SL;Chattat R;Fortuna D;Bucci L;Lanzarini C;Morsiani C;Catena F;Ansaloni L;Adversi M;Melotti MR;Di Nino G;Franceschi C
背景：术后谵妄（POD）是老年患者手术后常见的并发症，但其根本原因尚不清楚。我们假设炎症，老年人的亚临床低和慢性炎症特征，可以有助于POD的发病。因此，我们研究了择期和急诊手术的老年患者（> 65岁）术前和循环细胞因子的相关性。研究方法：这是对属于既往大型病例对照研究的患者子队列的二次分析，其中对351例患者进行了临床和认知方面的全面表征，并通过意识模糊评估方法和谵妄评定量表对POD（47例患者）进行了评估。从较大的生物库中选择了74份术前血浆样本，其中包括37例POD受试者和37例未POD受试者。炎症相关细胞因子，即，通过ELISA测定术前血液样本中的IL-1 β、IL-2、IL-6、IL-8、IL-10和TNF-α;单变量和多变量分析已用于鉴定与POD独立相关的细胞因子。细胞因子水平与功能状态、认知能力下降、院内死亡率和合并症的相关性也独立于POD发作进行了分析。结果：高IL-6和低IL-2水平与POD显著相关。在多变量分析中调整潜在混杂因素后，证实术前高水平IL-6与POD发作风险显著相关。高水平的IL-6也与一些基线特征（包括功能状态差、认知障碍、急诊入院和较高的合并症负担）和院内死亡率相关。结论：术前血浆IL-6水平升高（≥ 9 pg/mL）与POD发生显著相关。我们建议IL-6作为一个额外的危险因素，POD发病连同先前确定的因素。发现导致POD发作的所有危险因素将有助于改善住院患者的管理和降低医疗费用。
Background: Post-operative delirium (POD) is a common complication in elderly patients undergoing surgery, but the underpinning causes are not clear. We hypothesized that inflammaging, the subclinical low and chronic grade inflammation characteristic of old people, can contribute to POD onset. Accordingly, we investigated the association of pre-operative and circulating cytokines in elderly patients (>65 years), admitted for elective and emergency surgery. Methods: This is a secondary analysis of a sub-cohort of patients belonging to a previous large case–control study, where 351 patients were clinically and cognitively thoroughly characterized, together with the assessment of POD (47 patients) by confusion assessment method and delirium rating scale. Seventy-four pre-operative plasma samples were selected from a larger bio-bank and they included 37 subjects with POD and 37 without POD. Inflammaging related cytokines, i.e., IL-1β, IL-2, IL-6, IL-8, IL-10, and TNF-α, were assayed by ELISA in pre-operative blood samples; univariate and multivariable analyses have been applied to identify cytokines independently associated to POD. Associations of cytokine levels with functional status, cognitive decline, intra-hospital mortality, and comorbidity were also analyzed independently of POD onset. Results: High IL-6 and low-IL-2 levels were significantly associated with POD. After adjustment for potential confounders in multivariate analysis, high level of pre-operative IL-6 was confirmed to be significantly associated with risk of POD onset. High level of IL-6 was also associated with several baseline features (including poor functional status, cognitive impairment, emergency admission, and higher comorbidity burden) and intra-hospital mortality. Conclusion: Pre-operative, high-plasma level of IL-6 (≥9 pg/mL) was significantly associated with POD onset. We propose IL-6 as an additional risk factor of POD onset together with the previously identified factors. Discovery of all risk factors contributing to POD onset will permit to improve hospitalized patient management and the decrease of healthcare cost.
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影响因子：
15.1
作者：
Pollmächer, T;Haack, M;Yirmiya, R
通讯作者：
Yirmiya, R
影响因子：
2.6
作者：
van Munster, Barbara C.;Aronica, Eleonora;de Rooij, Sophia E. J. A.
通讯作者：
de Rooij, Sophia E. J. A.
影响因子：
7
作者：
Kazmierski, Jakub;Banys, Andrzej;Jaszewski, Ryszard
通讯作者：
Jaszewski, Ryszard
影响因子：
5.3
作者：
Franceschi, Claudio;Capri, Miriam;Salvioli, Stefano
通讯作者：
Salvioli, Stefano
DOI：
10.1111/j.1532-5415.2008.01851.x
发表时间：
2008-09-01
影响因子：
6.3
作者：
van Munster, Barbara C.;Korevaar, Johanna C.;De Rooij, Sophia E.
通讯作者：
De Rooij, Sophia E.