Intensive Care Medicine

, Volume 38, Issue 12, pp 1965–1973

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

Authors

    • Division of Allergy, Pulmonary, and Critical Care MedicineVanderbilt University School of Medicine
    • Center for Health Services ResearchVanderbilt University School of Medicine
    • Geriatric Research, Education and Clinical Center Service, Department of Veterans Affairs Medical CenterTennessee Valley Healthcare System
  • Lorraine B. Ware
    • Division of Allergy, Pulmonary, and Critical Care MedicineVanderbilt University School of Medicine
    • Department of Pathology, Microbiology and ImmunologyVanderbilt University School of Medicine
  • Gordon R. Bernard
    • Division of Allergy, Pulmonary, and Critical Care MedicineVanderbilt University School of Medicine
  • Pratik P. Pandharipande
    • Division of Critical Care, Department of AnesthesiologyVanderbilt University School of Medicine
    • Anesthesia Service, Department of Veterans Affairs Medical CenterTennessee Valley Healthcare System
  • Jennifer L. Thompson
    • Department of BiostatisticsVanderbilt University School of Medicine
  • Ayumi K. Shintani
    • Department of BiostatisticsVanderbilt University School of Medicine
  • James C. Jackson
    • Division of Allergy, Pulmonary, and Critical Care MedicineVanderbilt University School of Medicine
    • Department of PsychiatryVanderbilt University School of Medicine
    • Research Service, Department of Veterans Affairs Medical CenterTennessee Valley Healthcare System
  • Robert S. Dittus
    • Center for Health Services ResearchVanderbilt University School of Medicine
    • Division of General Internal Medicine and Public Health, Department of MedicineVanderbilt University School of Medicine
    • Geriatric Research, Education and Clinical Center Service, Department of Veterans Affairs Medical CenterTennessee Valley Healthcare System
  • E. Wesley Ely
    • Division of Allergy, Pulmonary, and Critical Care MedicineVanderbilt University School of Medicine
    • Center for Health Services ResearchVanderbilt University School of Medicine
    • Geriatric Research, Education and Clinical Center Service, Department of Veterans Affairs Medical CenterTennessee Valley Healthcare System
Original

DOI: 10.1007/s00134-012-2678-x

Cite this article as:
Girard, T.D., Ware, L.B., Bernard, G.R. et al. Intensive Care Med (2012) 38: 1965. doi:10.1007/s00134-012-2678-x

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

DeliriumInflammationBlood coagulationCritical illnessMechanical ventilation

Supplementary material

134_2012_2678_MOESM1_ESM.docx (62 kb)
Supplementary material 1 (DOCX 61 kb)
134_2012_2678_MOESM1_ESM.docx (62 kb)
Supplementary material 1 (DOCX 61 kb)
134_2012_2678_MOESM1_ESM.docx (62 kb)
Supplementary material 1 (DOCX 61 kb)

Copyright information

© Copyright jointly held by Springer and ESICM 2012