title: Pre-operative inflammatory markers and the risk of postoperative delirium in elderly patients.
abstract: OBJECTIVE
  Pathophysiological mechanisms leading to delirium are not clear. Age is a known risk factor and hypothesised to be accompanied by a low-grade inflammatory state. Previous studies have shown an association between delirium and circulating proinflammatory markers in acutely ill and postoperative patients. In light of the ageing/inflammation theory, we investigated the association of these markers with delirium in not acutely ill, elderly patients.
  
  
  METHODS
  In a prospective nested case-control study levels of C-reactive protein (CRP), interleukin 6 (Il-6), insulin growth factor 1 (IGF-1) were measured pre-operatively in elderly patients admitted for hip-surgery. These levels were compared between patients who later developed a post-operative delirium and patients who did not. Patients were matched for age and disease severity.
  
  
  RESULTS
  Eighteen patients who developed delirium post-operatively were matched with 50 controls. Median APACHE-scores were below 16 in both groups. Pre-operative serum concentrations of CRP, Il-6 and IGF-1 did not differ between groups. IL-6 levels were associated with a measure of cognitive impairment.
  
  
  CONCLUSIONS
  In the present study no relationship was found between levels of pre-operative circulating pro-inflammatory markers and post-operative delirium in elderly patients, who were free from acute or severe disease.
authors.affiliation: Department of Neurology, Academic Medical Centre, Amsterdam, The Netherlands. a.w.lemstra@gmail.com
authors.forename: Afina W
authors.initials: AW
authors.lastname: Lemstra
authors.forename: Kees J
authors.initials: KJ
authors.lastname: Kalisvaart
authors.forename: Ralph
authors.initials: R
authors.lastname: Vreeswijk
authors.forename: Willem A
authors.initials: WA
authors.lastname: van Gool
authors.forename: Piet
authors.initials: P
authors.lastname: Eikelenboom
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D016022:Case-Control Studies; D003072:Cognition Disorders / Q000175:diagnosis; D003693:Delirium / Q000175:diagnosis / Q000209:etiology / Q000378:metabolism*; D005260:Female; D006620:Hip Fractures / Q000601:surgery; D006801:Humans; D007249:Inflammation / Q000150:complications; D007334:Insulin-Like Growth Factor I / Q000378:metabolism*; D015850:Interleukin-6 / Q000378:metabolism*; D008297:Male; D009426:Netherlands; D011183:Postoperative Complications / Q000378:metabolism*; D011446:Prospective Studies
chemical_list: D015415:Biomarkers; D015850:Interleukin-6; D007334:Insulin-Like Growth Factor I; D002097:C-Reactive Protein