Differences in potential biomarkers of delirium between acutely ill medical and elective cardiac surgery patients
2019
markdownabstractBackground/aims: The pathophysiology of delirium is poorly understood. Increasing evidence
suggests that different pathways might be involved in the pathophysiology depending on the
population studied. The aim of the present study was to investigate potential differences in mean
plasma levels of neopterin, amino acids, amino acid ratios and homovanillic acid between two
groups of patients with delirium.
Methods: Data from acutely ill medical patients aged 65 years and older, and patients aged
70 years and older undergoing elective cardiac surgery, were used. Differences in biomarker
levels between the groups were investigated using univariate ANOVA with adjustments for age,
sex, comorbidities, C-reactive protein (CRP) and the estimated glomerular filtration rate (eGFR),
where appropriate. Linear regression analysis was used to identify potential determinants of the
investigated biochemical markers.
Results: Eighty patients with delirium were included (23 acutely ill medical patients and
57 elective cardiac surgery patients). After adjustment, higher mean neopterin levels (93.1 vs
47.3 nmol/L, P=0.001) and higher phenylalanine/tyrosine ratios (1.39 vs 1.15, P=0.032) were
found in acutely ill medical patients when compared to elective cardiac surgery patients. CRP
levels were positively correlated with neopterin levels in acutely ill medical patients, explaining
28.4% of the variance in neopterin levels. eGFR was negatively correlated with neopterin in
elective cardiac surgery patients, explaining 53.7% of the variance in neopterin levels.
Conclusion: In this study, we found differences in mean neopterin levels and phenylalanine/
tyrosine ratios between acutely ill medical and elective cardiac surgery patients with delirium.
Moreover, our findings may suggest that in acutely ill medical patients, neopterin levels are
mainly determined by inflammation/oxidative stress whereas in elective cardiac surgery patients,
neopterin levels are mainly driven by renal function/fluid status. These findings suggest that the
markers and pathways that might be involved in the pathophysiology of delirium may differ
between specific groups of patients.
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