Delirium in patients with acute ischemic stroke admitted to the non-intensive stroke unit: Incidence and association between clinical features and inflammatory markers.
BACKGROUND
Stroke patients with development of delirium have unfavorable outcomes, higher mortality, longer hospitalizations, and a greater degree of dependence after discharge. Studies suggest that delirium is associated with abnormal immunological responses and a resultant increase in inflammatory markers.


OBJECTIVE
Our aim was to determine whether there is an entity relationship between delirium, inflammation and acute ischemic stroke (AIS).


METHODS
Sixty AIS patients admitted to the hospital were consecutively recruited. Delirium was diagnosed with the clinical assessment according to the Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) criteria. Enzyme-linked immunosorbent assay (ELISA) was used to measure serum levels of Interleukin-1 beta (IL-1 beta), Interleukin 18 (IL-18), Tumor Necrosis Factor-alpha (TNF-alpha), Brain-Derived Neurotrophic Factor (BDNF), and Neuron Specific Enolase (NSE) at admission.


RESULTS
Eleven (18.3%) of 60 patients were diagnosed with delirium, and the majority (n=8, 72.7%) was the hypoactive type. Delirious and non-delirious patients had similar demographic and clinical features. Delirious patients had significantly higher lengths of hospital stay, National Institutes of Health Stroke Scale (NIHSS) at admission and discharge compared to non-delirious patients. In addition, there was no significant statistical difference between delirious and non-delirious patients with AIS in respect of levels of TNF-alpha, IL-1 beta, IL-18, BDNF and NSE. This study suggests that delirium is not scarce in patients with AIS admitted to the non-intensive stroke unit, and that delirium developing after AIS seems not to be associated with serum TNF-alpha, IL-1 beta, IL-18, BDNF and NSE but is associated with length of hospital stay and stroke severity.
Department of Neurology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey. Electronic address: hhkozak@gmail.com.
Hasan Hüseyin
HH
Kozak
Department of Psychiatry, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey.
Faruk
F
Uğuz
Department of Clinical Biochemistry, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey.
İbrahim
İ
Kılınç
Department of Neurology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey.
Ali Ulvi
AU
Uca
Department of Neurology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey.
Osman
O
Serhat Tokgöz
Department of Neurology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey.
Zehra
Z
Akpınar
Department of Clinical Biochemistry, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey.
Nejla
N
Özer
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002545:Brain Ischemia / Q000097:blood*; D019208:Brain-Derived Neurotrophic Factor / Q000097:blood; D016207:Cytokines / Q000097:blood*; D003693:Delirium / Q000097:blood*; D005260:Female; D006801:Humans; D015994:Incidence; D007249:Inflammation / Q000097:blood*; D020382:Interleukin-18 / Q000097:blood; D053583:Interleukin-1beta / Q000097:blood; D008297:Male; D008875:Middle Aged; D010751:Phosphopyruvate Hydratase / Q000097:blood; D020521:Stroke / Q000097:blood*; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
D015415:Biomarkers; D019208:Brain-Derived Neurotrophic Factor; D016207:Cytokines; C508585:IL1B protein, human; D020382:Interleukin-18; D053583:Interleukin-1beta; D014409:Tumor Necrosis Factor-alpha; C579455:BDNF protein, human; D010751:Phosphopyruvate Hydratase
Acute ischemic stroke; Cytokine; Delirium; Inflammation; Non-intensive care stroke unit