title: Chemokines are associated with delirium after cardiac surgery.
abstract: BACKGROUND
  Delirium has been hypothesized to be a central nervous system response to systemic inflammation during a state of blood-brain barrier compromise. The purpose of this study was to compare postoperative changes in groups of inflammatory markers in persons who developed delirium following cardiac surgery and matched controls without delirium.
  
  
  METHODS
  Serum samples were drawn from 42 patients undergoing cardiac surgery preoperatively and postoperatively at 6 hours and postoperative day 4. The serum concentrations of 28 inflammatory markers were determined with a microsphere flow cytometer. A priori, inflammatory markers were assigned to five classes of cytokines. A class z score was calculated by averaging the standardized, normalized levels of the markers in each class. Beginning on postoperative day 2, patients underwent a daily delirium assessment.
  
  
  RESULTS
  Twelve patients with delirium were matched by surgical duration, age, and baseline cognition to 12 patients without delirium. At the 6-hour time point, patients who went on to develop delirium had higher increases of chemokines compared to matched controls (class z score 0.3 +/- 1.0, p <.05). Among the five classes of cytokines, there were no other significant differences between patients with or without delirium at either the 6 hour or postoperative day 4 assessments.
  
  
  CONCLUSIONS
  After cardiac surgery, chemokine levels were elevated in patients who developed delirium in the early postoperative period. Because chemokines are capable of disrupting blood-brain barrier integrity in vitro, future studies are needed to define the relationship of these inflammatory mediators to delirium pathogenesis.
authors.affiliation: Geriatric Research, Education, and Clinical Center, 150 South Huntington Ave (JP-182), Boston, MA 02130, USA. jrudolph@partners.org
authors.forename: James L
authors.initials: JL
authors.lastname: Rudolph
authors.forename: Basel
authors.initials: B
authors.lastname: Ramlawi
authors.forename: George A
authors.initials: GA
authors.lastname: Kuchel
authors.forename: Janet E
authors.initials: JE
authors.lastname: McElhaney
authors.forename: Dongxu
authors.initials: D
authors.lastname: Xie
authors.forename: Frank W
authors.initials: FW
authors.lastname: Sellke
authors.forename: Kamal
authors.initials: K
authors.lastname: Khabbaz
authors.forename: Sue E
authors.initials: SE
authors.lastname: Levkoff
authors.forename: Edward R
authors.initials: ER
authors.lastname: Marcantonio
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D006348:Cardiac Surgical Procedures; D016022:Case-Control Studies; D018925:Chemokines / Q000097:blood*; D003693:Delirium / Q000097:blood* / Q000209:etiology; D005260:Female; D005434:Flow Cytometry; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000097:blood*; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D018925:Chemokines