Laboratorial parameters as predictors of Delirium in elderly subjects hospitalized with acute medical conditions

Abstract

Background: Delirium is a neuropsychiatric syndrome common in acute medically ill elderly patients during hospitalization. It is frequently unrecognized and leads to bad outcomes. Development of biomarkers to be used in conjunction with clinical assessment could allow delirium prevention. The aim of this study was to correlate commonly used laboratorial blood parameters (LP) with the presence of delirium and to determine whether these tests can predict a delirium episode in elderly patients with acute medical conditions.Methods: The study was prospective and observational. We screened 269 elderly male individuals admitted to a general medical ward with acute medical conditions. During four days of hospitalization, each patient was periodically assessed for the level of consciousness with the Richmond Agitation-Sedation Scale and for the presence of Delirium with the Confusion Assessment Method and Diagnostic and Statistical Manual of Mental Disorders-V criteria. The most recent LP before each mental status assessment were obtained from clinical records. Changes in LP during hospitalization were analyzed and compared between patients according to the presence of delirium. LP measures were compared between subjects according to the presence of delirium or considerable sedation at different times during hospitalization. LP were also analyzed according to the presence of altered arousal. Statistical analysis was performed using IBM SPSS Statistics 24.0.Results: On admission, 15,4% of the participants had delirium. Leukocytes (Lc), glucose, creatinine, blood urea nitrogen, creatine kinase (CK), C-reactive protein, sodium (Na), potassium (K) and gamma glutamyl transferase changed significantly during hospitalization. During the first half of hospital stay, delirious patients tended to present decreasing aspartate transaminase (AST) and alkaline phosphatase, while these LP varied in narrower ranges than those observed in subjects without delirium. Changes in LP during the second half of hospitalization didn´t differ according to the presence of delirium. In terms of mean LP, delirium was associated with higher AST and Na levels as well as lower Lc, platelet and K values, considering different assessments during hospital stay. Also, altered arousal was associated with elevated CK levels.Discussion and Conclusions: Changes in some LP during hospitalization reflected different physiological reactions to regain homeostasis following an acute medical condition. And our results suggest that liver function particularly influences brain failure during the early stages of this altered homeostasis. We couldn´t find enough evidence to determine commonly used laboratory tests as predictors of a delirium episode in elderly patients with acute medical conditions.

Background: Delirium is a neuropsychiatric syndrome common in acute medically ill elderly patients during hospitalization. It is frequently unrecognized and leads to bad outcomes. Development of biomarkers to be used in conjunction with clinical assessment could allow delirium prevention. The aim of this study was to correlate commonly used laboratorial blood parameters (LP) with the presence of delirium and to determine whether these tests can predict a delirium episode in elderly patients with acute medical conditions.Methods: The study was prospective and observational. We screened 269 elderly male individuals admitted to a general medical ward with acute medical conditions. During four days of hospitalization, each patient was periodically assessed for the level of consciousness with the Richmond Agitation-Sedation Scale and for the presence of Delirium with the Confusion Assessment Method and Diagnostic and Statistical Manual of Mental Disorders-V criteria. The most recent LP before each mental status assessment were obtained from clinical records. Changes in LP during hospitalization were analyzed and compared between patients according to the presence of delirium. LP measures were compared between subjects according to the presence of delirium or considerable sedation at different times during hospitalization. LP were also analyzed according to the presence of altered arousal. Statistical analysis was performed using IBM SPSS Statistics 24.0.Results: On admission, 15,4% of the participants had delirium. Leukocytes (Lc), glucose, creatinine, blood urea nitrogen, creatine kinase (CK), C-reactive protein, sodium (Na), potassium (K) and gamma glutamyl transferase changed significantly during hospitalization. During the first half of hospital stay, delirious patients tended to present decreasing aspartate transaminase (AST) and alkaline phosphatase, while these LP varied in narrower ranges than those observed in subjects without delirium. Changes in LP during the second half of hospitalization didn´t differ according to the presence of delirium. In terms of mean LP, delirium was associated with higher AST and Na levels as well as lower Lc, platelet and K values, considering different assessments during hospital stay. Also, altered arousal was associated with elevated CK levels.Discussion and Conclusions: Changes in some LP during hospitalization reflected different physiological reactions to regain homeostasis following an acute medical condition. And our results suggest that liver function particularly influences brain failure during the early stages of this altered homeostasis. We couldn´t find enough evidence to determine commonly used laboratory tests as predictors of a delirium episode in elderly patients with acute medical conditions.