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Saller T, Peterss S, Scheiermann P, Eser-Valeri D, Ehler J, Bruegger D, Chappell D, Kofler O, Hagl C, Hofmann-Kiefer K. Natriuretic Peptides as a Prognostic Marker for Delirium in Cardiac Surgery-A Pilot Study. ACTA ACUST UNITED AC 2020; 56:medicina56060258. [PMID: 32471143 PMCID: PMC7353880 DOI: 10.3390/medicina56060258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 05/19/2020] [Accepted: 05/22/2020] [Indexed: 11/16/2022]
Abstract
Background and Objectives: Delirium is a common and major complication subsequent to cardiac surgery. Despite scientific efforts, there are no parameters which reliably predict postoperative delirium. In delirium pathology, natriuretic peptides (NPs) interfere with the blood–brain barrier and thus promote delirium. Therefore, we aimed to assess whether NPs may predict postoperative delirium and long-term outcomes. Materials and Methods: To evaluate the predictive value of NPs for delirium we retrospectively analyzed data from a prospective, randomized study for serum levels of atrial natriuretic peptide (ANP) and the precursor of C-type natriuretic peptide (NT-proCNP) in patients undergoing coronary artery bypass grafting (CABG) with or without cardiopulmonary bypass (off-pump coronary bypass grafting; OPCAB). Delirium was assessed by a validated chart-based method. Long-term outcomes were assessed 10 years after surgery by a telephone interview. Results: The overall incidence of delirium in the total cohort was 48% regardless of the surgical approach (CABG vs. OPCAB). Serum ANP levels > 64.6 pg/mL predicted delirium with a sensitivity (95% confidence interval) of 100% (75.3–100) and specificity of 42.9% (17.7–71.1). Serum NT-proCNP levels >1.7 pg/mL predicted delirium with a sensitivity (95% confidence interval) of 92.3% (64.0–99.8) and specificity of 42.9% (17.7–71.1). Both NPs could not predict postoperative survival or long-term cognitive decline. Conclusions: We found a positive correlation between delirium and preoperative plasma levels of ANP and NT-proCNP. A well-powered and prospective study might identify NPs as biomarkers indicating the risk of delirium and postoperative cognitive decline in patients at risk for postoperative delirium.
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Affiliation(s)
- Thomas Saller
- Department of Anaesthesiology, University Hospital, LMU Munich, 81377 Munich, Germany; (P.S.); (D.B.); (O.K.); (K.H.-K.)
- Correspondence: ; Tel.: +49-89-4400-73410
| | - Sven Peterss
- Department of Cardiac Surgery, University Hospital, LMU Munich, 81377 Munich, Germany; (S.P.); (C.H.)
| | - Patrick Scheiermann
- Department of Anaesthesiology, University Hospital, LMU Munich, 81377 Munich, Germany; (P.S.); (D.B.); (O.K.); (K.H.-K.)
| | - Daniela Eser-Valeri
- Department of Psychiatry, University Hospital, LMU Munich, 80336 Munich, Germany;
| | - Johannes Ehler
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Center, 18057 Rostock, Germany;
| | - Dirk Bruegger
- Department of Anaesthesiology, University Hospital, LMU Munich, 81377 Munich, Germany; (P.S.); (D.B.); (O.K.); (K.H.-K.)
| | - Daniel Chappell
- Clinic for Anaesthesia, Surgical Intensive Care, Emergency Medicine and Pain Therapy, Klinikum Frankfurt Hoechst, 65929 Frankfurt/Main, Germany;
| | - Othmar Kofler
- Department of Anaesthesiology, University Hospital, LMU Munich, 81377 Munich, Germany; (P.S.); (D.B.); (O.K.); (K.H.-K.)
| | - Christian Hagl
- Department of Cardiac Surgery, University Hospital, LMU Munich, 81377 Munich, Germany; (S.P.); (C.H.)
| | - Klaus Hofmann-Kiefer
- Department of Anaesthesiology, University Hospital, LMU Munich, 81377 Munich, Germany; (P.S.); (D.B.); (O.K.); (K.H.-K.)
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Hughes CG, Patel MB, Brummel NE, Thompson JL, McNeil JB, Pandharipande PP, Jackson JC, Chandrasekhar R, Ware LB, Ely EW, Girard TD. Relationships between markers of neurologic and endothelial injury during critical illness and long-term cognitive impairment and disability. Intensive Care Med 2018. [PMID: 29523900 DOI: 10.1007/s00134-018-5120-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE Neurologic and endothelial injury biomarkers are associated with prolonged delirium during critical illness and may reflect injury pathways that lead to poor long-term outcomes. We hypothesized that blood-brain barrier (BBB), neuronal, and endothelial injury biomarkers measured during critical illness are associated with cognitive impairment and disability after discharge. METHODS We enrolled adults with respiratory failure and/or shock and measured plasma concentrations of BBB (S100B), neuronal (UCHL1, BDNF), and endothelial (E-selectin, PAI-1) injury markers within 72 h of ICU admission. At 3 and 12 months post-discharge, we assessed participants' global cognition, executive function, and activities of daily living (ADL). We used multivariable regression to determine whether biomarkers were associated with outcomes after adjusting for relevant demographic and acute illness covariates. RESULTS Our study included 419 survivors of critical illness with median age 59 years and APACHE II score 25. Higher S100B was associated with worse global cognition at 3 and 12 months (P = 0.008; P = 0.01). UCHL1 was nonlinearly associated with global cognition at 3 months (P = 0.02). Higher E-selectin was associated with worse global cognition (P = 0.006 at 3 months; P = 0.06 at 12 months). BDNF and PAI-1 were not associated with global cognition. No biomarkers were associated with executive function. Higher S100B (P = 0.05) and E-selectin (P = 0.02) were associated with increased disability in ADLs at 3 months. CONCLUSIONS S100B, a marker of BBB and/or astrocyte injury, and E-selectin, an adhesion molecule and marker of endothelial injury, are associated with long-term cognitive impairment after critical illness, findings that may reflect mechanisms of critical illness brain injury.
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Affiliation(s)
- Christopher G Hughes
- Department of Anesthesiology, Division of Anesthesiology Critical Care Medicine and Center for Health Services Research, Vanderbilt University Medical Center, Nashville, USA. .,Nashville Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, USA.
| | - Mayur B Patel
- Section of Surgical Sciences, Departments of Surgery, Neurosurgery and Hearing and Speech Sciences, Division of Trauma and Surgical Critical Care, Vanderbilt Brain Institute, Center for Health Services Research, Vanderbilt University Medical Center, Nashville, USA.,Nashville Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, USA
| | - Nathan E Brummel
- Department of Medicine, Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, USA
| | - Jennifer L Thompson
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, USA
| | - J Brennan McNeil
- Department of Medicine, Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, USA
| | - Pratik P Pandharipande
- Departments of Anesthesiology and Surgery, Division of Anesthesiology Critical Care Medicine, Vanderbilt University Medical Center, Nashville, USA.,Nashville Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, USA
| | - James C Jackson
- Department of Medicine, Division of Allergy, Pulmonary, and Critical Care Medicine and Center for Health Services Research, Vanderbilt University Medical Center, Nashville, USA.,Research Service, Nashville Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, USA
| | - Rameela Chandrasekhar
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, USA
| | - Lorraine B Ware
- Departments of Medicine and Pathology, Microbiology and Immunology, Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, USA
| | - E Wesley Ely
- Department of Medicine, Division of Allergy, Pulmonary, and Critical Care Medicine and Center for Health Services Research, Vanderbilt University Medical Center, Nashville, USA.,Geriatric Research, Education and Clinical Center Service, Nashville Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, USA
| | - Timothy D Girard
- Department of Critical Care Medicine and Clinical Research, Investigation and Systems Modeling of Acute Illnesses Center, University of Pittsburgh, Pittsburgh, USA
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