title: Preoperative CSF Melatonin Concentrations and the Occurrence of Delirium in Older Hip Fracture Patients: A Preliminary Study.
abstract: BACKGROUND
  Delirium is characterized by disturbances in circadian rhythm. Melatonin regulates our circadian rhythm. Our aim was to compare preoperative cerebrospinal fluid (CSF) melatonin levels in patients with and without postoperative delirium.
  
  
  METHODS
  Prospective cohort study with hip fracture patients ≥ 65 years who were acutely admitted to the hospital for surgical treatment and received spinal anaesthesia. CSF was collected after cannulation, before administering anaesthetics. Melatonin was measured by radioimmunoassay (RIA). Data on delirium was obtained from medical and nursing records. Nurses screened every shift for delirium using the Delirium Observation Screening Scale (DOSS). If the DOSS was ≥3, a psychiatrist was consulted to diagnose possible delirium using the DSM-IV criteria. At admission, demographic data, medical history, and information on functional and cognitive status was obtained.
  
  
  RESULTS
  Seventy-six patients met the inclusion criteria. Sixty patients were included in the analysis. Main reasons for exclusion were technical difficulties, insufficient CSF or exogenous melatonin use. Thirteen patients (21.7%) experienced delirium during hospitalisation. Baseline characteristics did not differ between patients with and without postoperative delirium. In patients with and without postoperative delirium melatonin levels were 12.88 pg/ml (SD 6.3) and 11.72 pg/ml (SD 4.5) respectively, p-value 0.47. No differences between patients with and without delirium were found in mean melatonin levels in analyses stratified for cognitive impairment or age.
  
  
  CONCLUSIONS
  Preoperative CSF melatonin levels did not differ between patients with and without postoperative delirium. This suggests that, if disturbances in melatonin secretion occur, these might occur after surgery due to postoperative inflammation.
authors.affiliation: Academic Medical Center, University of Amsterdam, Department of Internal Medicine, Geriatrics section, Amsterdam, The Netherlands.
authors.forename: Rikie M
authors.initials: RM
authors.lastname: Scholtens
authors.affiliation: Academic Medical Center, University of Amsterdam, Department of Internal Medicine, Geriatrics section, Amsterdam, The Netherlands.|University Medical Center Groningen, University Centre for Geriatric Medicine, Groningen, The Netherlands.
authors.forename: Sophia E J A
authors.initials: SE
authors.lastname: de Rooij
authors.affiliation: Erasmus Medical Center, Department of Urology, Rotterdam, The Netherlands.
authors.forename: Annelies E
authors.initials: AE
authors.lastname: Vellekoop
authors.affiliation: Sint Lucas Andreas Hospital, Department of Surgery, Amsterdam, The Netherlands.
authors.forename: Bart C
authors.initials: BC
authors.lastname: Vrouenraets
authors.affiliation: University Medical Center Groningen, University Centre for Geriatric Medicine, Groningen, The Netherlands.|Gelre Hospitals, Department of Geriatrics, Apeldoorn, The Netherlands.
authors.forename: Barbara C
authors.initials: BC
authors.lastname: van Munster
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002940:Circadian Rhythm; D003693:Delirium / Q000134:cerebrospinal fluid* / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D006620:Hip Fractures / Q000150:complications / Q000601:surgery*; D006801:Humans; D008297:Male; D008550:Melatonin / Q000134:cerebrospinal fluid*; D011183:Postoperative Complications / Q000134:cerebrospinal fluid* / Q000175:diagnosis / Q000209:etiology*; D057234:Preoperative Period; D011446:Prospective Studies
chemical_list: D008550:Melatonin