Journal Article

Delirium due to hip fracture is associated with activated immune-inflammatory pathways and a reduction in negative immunoregulatory mechanisms

Tantavisut, Saran, Maes, Michael, Thisayakorn, Paul, Thipakorn, Yanin, Sirivichayakul, Sunee

2022

Overview

Background The objectives of this study were to delineate whether delirium in older adults is associated with activation of the immune-inflammatory response system (IRS) as indicated by activation of M1, T helper (Th)1, and Th17 profiles, and/or by reduced activities of the compensatory immunoregulatory system (CIRS), including Th2 and T regulatory profiles. Methods We recruited 65 older adult patients with a low energy impact hip fracture who underwent hip fracture operation. The CAM-ICU and the Delirium Rating Scale, Revised-98-Thai version (DRS-R-98) were assessed pre-operatively and 1, 2 and 3 days after surgery. Blood samples (day 1 and 2) post-surgery were assayed for cytokines/chemokines using a MultiPlex assay and the neutrophil/lymphocyte ratio. Results We found that delirium and/or the DRS-R-98 score were associated with IRS activation as indicated by activated M1, Th1, Th17 and T cell growth profiles and by attenuated CIRS functions. The most important IRS biomarkers were CXCL8, interleukin (IL)-6, and tumor necrosis factor-α, and the most important CIRS biomarkers were IL-4 and soluble IL-1 receptor antagonist. We found that 42.5% of the variance in the actual changes in the DRS-R-98 score (averaged from day 1 to day 3) was explained by T cell growth factors, baseline DRS-R-98 scores and age. An increase in the NLR reflects overall IRS, M1, Th1, Th17, and Th2 activation. Conclusions Post-hip surgery delirium is associated with activated IRS pathways and appears especially in patients with lowered CIRS functions.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Aged / Alzheimer's disease / Biomarkers / Blood / Brain research / Cell growth / Chemokines / Cytokines / Delirium / Delirium - complications / Dementia / Fractures / Genetic aspects / Growth factors / Helper cells / Hip / Hip fracture / Hip Fractures - complications / Hip Fractures - surgery / Hip joint / Humans / Immunoregulation / Inflammation / Intensive care / Interleukin 1 / Interleukin 1 receptor antagonist / Interleukin 4 / Leukocytes (neutrophilic) / Lymphocytes / Lymphocytes T / Medicine / Medicine & Public Health / Neuroimmune / Neurotoxicity / Neutrophils / Older people / Pathophysiology / Patient outcomes / Patients / Physiological aspects / Psychiatry / Psychological aspects / Psychotherapy / Risk factors / Schizophrenia / Surgery / Tumor Necrosis Factor-alpha / Tumor necrosis factor-α