Correlation of preoperative inflammatory factors and emotional disorders with postoperative delirium in patients with craniocerebral trauma

IF 3.9 4区医学 Q1 PSYCHIATRY

World Journal of Psychiatry Pub Date : 2024-07-19 DOI:10.5498/wjp.v14.i7.1043

Peng Cao, Zheyong Jia, T. Zheng, Tao Mei

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Abstract

BACKGROUND Traumatic brain injury (TBI) imposes a substantial societal and familial burden due to its high disability and fatality rates, rendering it a serious public health problem. Some patients with TBI have poor treatment outcomes and are prone to postoperative delirium (POD), which affects their quality of life. Anxiety has been linked to increased POD incidence in some studies, while others have found no correlation. AIM To investigate the correlation of POD risk factors, preoperative inflammatory factors, and mood disorders in patients with TBI. METHODS We retrospectively collected data on the treatment of 80 patients with TBI from November 2021 to September 2023. Patients were grouped as POD and non-POD, according to their POD status, and the general data of the two groups were compared. Inflammatory factor levels were detected preoperatively, and the Hamilton Depression Scale (HAMD) and Hamilton Anxiety Scale (HAMA) were used to investigate the risk factors associated with POD in these patients. Logistic regression was used to identify the independent risk factors. RESULTS Twenty-one patients (26.25%) developed POD, including 7, 10, and 4 cases of the excitatory, inhibitory, and mixed types, respectively. There were 59 cases (73.75%) in the non-POD group. Compared with the non-POD group, the POD group had a significantly higher proportion of patients with low Glasgow Coma Scale (GCS) scores before admission, unilateral mydriasis, preoperative hemorrhagic shock, intraventricular hemorrhage (IVH), and postoperative hyperglycemic hyperosmolar disease (P < 0.05). In the POD group, interleukin-6 (IL-6), human tumor necrosis factor-α (TNF-α), myeloperoxidase levels, HAMA, and HAMD scores were higher than those in the non-POD group (all P < 0.05). Logistic multivariate analysis showed that GCS score at admission, IVH, IL-6, TNF-α, HAMA, and HAMD were independent risk factors for POD in patients with TBI (P < 0.05). CONCLUSION Low GCS score at admission, IVH, elevated IL-6 and TNF-α, other inflammatory indicators, anxiety, and depression, can increase the risk of POD in patients with TBI after surgery.

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颅脑外伤患者术前炎症因素和情绪障碍与术后谵妄的相关性

背景创伤性脑损伤（TBI）因其高致残率和致死率给社会和家庭带来了沉重的负担，使其成为一个严重的公共卫生问题。一些创伤性脑损伤患者的治疗效果不佳，而且容易出现术后谵妄（POD），影响他们的生活质量。在一些研究中，焦虑与 POD 发生率的增加有关，而另一些研究则发现两者之间没有相关性。目的探讨创伤性脑损伤患者 POD 风险因素、术前炎症因素和情绪障碍的相关性。方法我们回顾性收集了 2021 年 11 月至 2023 年 9 月期间 80 名创伤性脑损伤患者的治疗数据。根据 POD 状态将患者分为 POD 和非 POD 两组，并比较两组的一般数据。术前检测炎症因子水平，并使用汉密尔顿抑郁量表（HAMD）和汉密尔顿焦虑量表（HAMA）调查这些患者与POD相关的风险因素。采用逻辑回归法确定独立的风险因素。结果 21 例患者（26.25%）出现了 POD，其中兴奋型、抑制型和混合型患者分别为 7 例、10 例和 4 例。非 POD 组有 59 例（73.75%）。与非 POD 组相比，POD 组患者入院前格拉斯哥昏迷量表（GCS）评分低、单侧瞳孔散大、术前失血性休克、脑室内出血（IVH）和术后高血糖高渗疾病的比例明显更高（P < 0.05）。POD 组的白细胞介素-6（IL-6）、人肿瘤坏死因子-α（TNF-α）、髓过氧化物酶水平、HAMA 和 HAMD 评分均高于非 POD 组（均 P <0.05）。逻辑多变量分析显示，入院时的 GCS 评分、IVH、IL-6、TNF-α、HAMA 和 HAMD 是 TBI 患者 POD 的独立危险因素（P < 0.05）。结论入院时 GCS 评分低、IVH、IL-6 和 TNF-α、其他炎症指标升高、焦虑和抑郁可增加 TBI 患者术后 POD 的风险。

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来源期刊

World Journal of Psychiatry PSYCHIATRY-

自引率

6.50%

发文量

110

期刊介绍： The World Journal of Psychiatry (WJP) is a high-quality, peer reviewed, open-access journal. The primary task of WJP is to rapidly publish high-quality original articles, reviews, editorials, and case reports in the field of psychiatry. In order to promote productive academic communication, the peer review process for the WJP is transparent; to this end, all published manuscripts are accompanied by the anonymized reviewers’ comments as well as the authors’ responses. The primary aims of the WJP are to improve diagnostic, therapeutic and preventive modalities and the skills of clinicians and to guide clinical practice in psychiatry.