Association of Central Nervous System-Related Biomarkers With Hospital Delirium in Patients With Respiratory Failure in the ICU

Andrew T. Pham MD , Ryan A. Peterson PhD , Suzanne Slaughter MS , Morgan Martin BS , Joseph A. Hippensteel MD , Ellen L. Burnham MD
{"title":"Association of Central Nervous System-Related Biomarkers With Hospital Delirium in Patients With Respiratory Failure in the ICU","authors":"Andrew T. Pham MD ,&nbsp;Ryan A. Peterson PhD ,&nbsp;Suzanne Slaughter MS ,&nbsp;Morgan Martin BS ,&nbsp;Joseph A. Hippensteel MD ,&nbsp;Ellen L. Burnham MD","doi":"10.1016/j.chstcc.2025.100143","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Delirium commonly occurs in critical illness and is associated with significant morbidity and mortality. Although risk reduction measures can mitigate the risk of delirium, identifying patients in whom delirium will develop remains clinically challenging.</div></div><div><h3>Research Question</h3><div>In critically ill patients with respiratory failure, are central nervous system (CNS)-related biomarkers measured at admission associated with delirium diagnosis?</div></div><div><h3>Study Design and Methods</h3><div>We performed a secondary analysis of a cohort of patients with respiratory failure in the medical ICU enrolled at a single medical center. Using serum collected at ICU admission, we measured CNS-related biomarkers including brain-derived neurotrophic factor (BDNF), chitinase-3-like protein 1, glial fibrillary acidic protein, neurofilament light chain (NF-L), neurogranin, S100 calcium-binding protein B, and triggering receptor expressed on myeloid cells 2 via a multiplex immunoassay. The primary outcome was diagnosis of in-hospital delirium, defined using validated methods. Associations between individual biomarkers and delirium diagnosis were examined using multivariable logistic regressions, adjusting for factors known to predispose and precipitate delirium. Secondary outcomes included in-hospital mortality, ventilator-free days, ICU-free days, and hospital-free days.</div></div><div><h3>Results</h3><div>Serum biomarkers were measured in 100 patients. Delirium occurred in 73% of the cohort. Patients with vs without delirium did not differ significantly in terms of age, sex, comorbidities, severity of illness, or unhealthy alcohol use. After adjustment, NF-L was associated positively with delirium diagnosis (adjusted OR, 1.86; 95% CI, 1.09-3.43), whereas BDNF was associated negatively with delirium (adjusted OR, 0.43; 95% CI, 0.15-0.82). No associations were found between other measured biomarkers and delirium diagnosis. NF-L levels were associated negatively with ICU-free and hospital-free days.</div></div><div><h3>Interpretation</h3><div>Our results indicate that CNS-related biomarkers measured at ICU admission are associated with delirium diagnosis in critically ill patients. Prospective investigations are necessary to validate the role of these biomarkers in predicting delirium.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 2","pages":"Article 100143"},"PeriodicalIF":0.0000,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"CHEST critical care","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2949788425000164","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0

Abstract

Background

Delirium commonly occurs in critical illness and is associated with significant morbidity and mortality. Although risk reduction measures can mitigate the risk of delirium, identifying patients in whom delirium will develop remains clinically challenging.

Research Question

In critically ill patients with respiratory failure, are central nervous system (CNS)-related biomarkers measured at admission associated with delirium diagnosis?

Study Design and Methods

We performed a secondary analysis of a cohort of patients with respiratory failure in the medical ICU enrolled at a single medical center. Using serum collected at ICU admission, we measured CNS-related biomarkers including brain-derived neurotrophic factor (BDNF), chitinase-3-like protein 1, glial fibrillary acidic protein, neurofilament light chain (NF-L), neurogranin, S100 calcium-binding protein B, and triggering receptor expressed on myeloid cells 2 via a multiplex immunoassay. The primary outcome was diagnosis of in-hospital delirium, defined using validated methods. Associations between individual biomarkers and delirium diagnosis were examined using multivariable logistic regressions, adjusting for factors known to predispose and precipitate delirium. Secondary outcomes included in-hospital mortality, ventilator-free days, ICU-free days, and hospital-free days.

Results

Serum biomarkers were measured in 100 patients. Delirium occurred in 73% of the cohort. Patients with vs without delirium did not differ significantly in terms of age, sex, comorbidities, severity of illness, or unhealthy alcohol use. After adjustment, NF-L was associated positively with delirium diagnosis (adjusted OR, 1.86; 95% CI, 1.09-3.43), whereas BDNF was associated negatively with delirium (adjusted OR, 0.43; 95% CI, 0.15-0.82). No associations were found between other measured biomarkers and delirium diagnosis. NF-L levels were associated negatively with ICU-free and hospital-free days.

Interpretation

Our results indicate that CNS-related biomarkers measured at ICU admission are associated with delirium diagnosis in critically ill patients. Prospective investigations are necessary to validate the role of these biomarkers in predicting delirium.
中枢神经系统相关生物标志物与ICU呼吸衰竭患者谵妄的关系
背景:谵妄常见于危重疾病,并与显著的发病率和死亡率相关。虽然降低风险的措施可以减轻谵妄的风险,但确定谵妄将发展的患者在临床上仍然具有挑战性。在呼吸衰竭的危重患者中,入院时测量中枢神经系统(CNS)相关生物标志物是否与谵妄诊断相关?研究设计和方法我们对在单一医疗中心入组的ICU呼吸衰竭患者队列进行了二次分析。使用ICU入院时收集的血清,我们通过多重免疫分析法测量了中枢神经系统相关的生物标志物,包括脑源性神经营养因子(BDNF)、几丁质酶-3样蛋白1、胶质纤维酸性蛋白、神经丝轻链(NF-L)、神经粒蛋白、S100钙结合蛋白B和髓细胞上表达的触发受体2。主要结局是诊断为院内谵妄,使用有效的方法定义。个体生物标志物与谵妄诊断之间的关联使用多变量逻辑回归进行了检验,调整了已知的易患和沉淀谵妄的因素。次要结局包括住院死亡率、无呼吸机天数、无icu天数和无住院天数。结果对100例患者进行血清生物标志物检测。73%的患者出现谵妄。谵妄患者与非谵妄患者在年龄、性别、合并症、疾病严重程度或不健康饮酒方面没有显著差异。调整后,NF-L与谵妄诊断呈正相关(调整OR为1.86;95% CI, 1.09-3.43),而BDNF与谵妄呈负相关(校正OR, 0.43;95% ci, 0.15-0.82)。其他测量的生物标志物与谵妄诊断之间未发现关联。NF-L水平与无icu和无住院天数呈负相关。我们的研究结果表明,ICU入院时测量的中枢神经系统相关生物标志物与危重患者谵妄诊断相关。有必要进行前瞻性研究,以验证这些生物标志物在预测谵妄中的作用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
CHEST critical care
CHEST critical care Critical Care and Intensive Care Medicine, Pulmonary and Respiratory Medicine
自引率
0.00%
发文量
0
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信