title: Lack of Association between Pre-Operative Insulin-Like Growth Factor-1 and the Risk of Post-Operative Delirium in Elderly Chinese Patients.
abstract: OBJECTIVE
  Postoperative delirium (POD) is a highly prevalent complex neuropsychiatric syndrome in elderly patients. However, its pathophysiology is currently unknown. Early detection and prevention of POD is important; therefore, the aim of this study was to investigate the link between preoperative insulin growth factor 1 (IGF-1) levels in the serum and POD in the Chinese elderly patients.
  
  
  METHODS
  One hundred and three patients who were undergoing an orthopedic operation took part in the study. Preoperative serum IGF-1 levels were measured. POD was determined daily using the Confusion Assessment Method (CAM) and DSM-IV TR. Baseline serum IGF-1 levels were compared between patients who did and did not develop POD. Correlation coefficients were calculated to evaluate relationship between baseline characteristics and serum IGF-1 levels. The relationship between baseline biomarkers and delirium status was investigated using logistic regression analysis, adjusting for potential confounding variables.
  
  
  RESULTS
  Twenty-three patients developed POD. The POD group had lower MMSE scores and higher CCI scores and proportions of acute admission. Preoperative serum IGF-1 levels were correlated with MMSE scores and age (MMSE: r=0.230, p<0.05; age: r=-0.419, p<0.001). Baseline serum IGF-1 levels did not differ between patients who did and did not develop POD, even after adjusting for potential confounding factors, MMSE score, and age.
  
  
  CONCLUSIONS
  No association was found between preoperative IGF-1 levels and POD, suggesting that they are not direct biomarkers of the incidence of POD among the Chinese elderly population. Further research with larger sample sizes is warranted to clarify the relationship.
authors.affiliation: Department of Psychiatry, Puli Branch, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: Che-Sheng
authors.initials: CS
authors.lastname: Chu
authors.affiliation: Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.; Division of Neurology, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Chih-Kuang
authors.initials: CK
authors.lastname: Liang
authors.affiliation: Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.; Department of Medical Education, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
authors.forename: Ming-Yueh
authors.initials: MY
authors.lastname: Chou
authors.affiliation: Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.; Division of Neurology, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
authors.forename: Yu-Te
authors.initials: YT
authors.lastname: Lin
authors.affiliation: Department of Medical Education, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
authors.forename: Chien-Jen
authors.initials: CJ
authors.lastname: Hsu
authors.affiliation: Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.; Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
authors.forename: Chin-Liang
authors.initials: CL
authors.lastname: Chu
authors.affiliation: Department of Psychiatry, Taichung Veterans General Hospital, Taichung, Taiwan.; Department of Psychiatry, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Po-Han
authors.initials: PH
authors.lastname: Chou
keywords: Elderly; IGF-1; Postoperative delirium