Original

Intensive Care Medicine

, Volume 38, Issue 12, pp 1965-1973

First online:

Associations of markers of inflammation and coagulation with delirium during critical illness

  • Timothy D. GirardAffiliated withDivision of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University School of MedicineCenter for Health Services Research, Vanderbilt University School of MedicineGeriatric Research, Education and Clinical Center Service, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System Email author 
  • , Lorraine B. WareAffiliated withDivision of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University School of MedicineDepartment of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine
  • , Gordon R. BernardAffiliated withDivision of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University School of Medicine
  • , Pratik P. PandharipandeAffiliated withDivision of Critical Care, Department of Anesthesiology, Vanderbilt University School of MedicineAnesthesia Service, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System
  • , Jennifer L. ThompsonAffiliated withDepartment of Biostatistics, Vanderbilt University School of Medicine
  • , Ayumi K. ShintaniAffiliated withDepartment of Biostatistics, Vanderbilt University School of Medicine
  • , James C. JacksonAffiliated withDivision of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University School of MedicineDepartment of Psychiatry, Vanderbilt University School of MedicineResearch Service, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System
  • , Robert S. DittusAffiliated withCenter for Health Services Research, Vanderbilt University School of MedicineDivision of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University School of MedicineGeriatric Research, Education and Clinical Center Service, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System
  • , E. Wesley ElyAffiliated withDivision of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University School of MedicineCenter for Health Services Research, Vanderbilt University School of MedicineGeriatric Research, Education and Clinical Center Service, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System

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Abstract

Purpose

To assess the associations between a priori-selected markers of inflammation and coagulation and delirium during critical illness.

Methods

In this prospective cohort study, we collected blood from mechanically ventilated medical intensive care unit (ICU) patients and measured nine plasma markers of inflammation and coagulation. We assessed patients daily for delirium using the Confusion Assessment Method for the ICU and used multivariable regression to analyze the associations between plasma markers and subsequent delirium, after adjusting for age, severity of illness, and sepsis.

Results

Among the 138 patients studied, with median age of 66 years and median Acute Physiology and Chronic Health Evaluation (APACHE) II of 27, 107 (78 %) were delirious at some point during the study. Two markers of inflammation and one of coagulation were significantly associated with delirium. After adjusting for covariates, lower plasma concentrations of matrix metalloproteinase-9 (MMP-9) and protein C were associated with increased probability of delirium (p = 0.04 and 0.01, respectively), and higher concentrations of soluble tumor necrosis factor receptor-1 (sTNFR1) were associated with increased probability of delirium (p < 0.01). Concentrations of C-reactive protein (p = 0.82), myeloperoxidase (p = 0.11), neutrophil gelatinase-associated lipocalin (p = 0.70), D-dimer (p = 0.83), plasminogen activator inhibitor type 1 (p = 0.98), and Von Willebrand factor antigen (p = 0.65) were not associated with delirium.

Conclusions

In this study, MMP-9, protein C, and sTNFR1 were independently associated with subsequent ICU delirium. These results suggest that specific aspects of inflammation and coagulation may play a role in the evolution of delirium during critical illness and that these markers should be examined in larger studies of ICU patients.

Keywords

Delirium Inflammation Blood coagulation Critical illness Mechanical ventilation