Preoperative Cerebrospinal Fluid Cortisol and the Risk of Postoperative Delirium: A Prospective Study of Older Hip Fracture Patients.
Aged
Aged, 80 and over
Delirium
/ cerebrospinal fluid
Female
Hip Fractures
/ cerebrospinal fluid
Humans
Hydrocortisone
/ cerebrospinal fluid
Hypothalamo-Hypophyseal System
/ physiopathology
Male
Pituitary-Adrenal System
/ physiopathology
Postoperative Complications
/ cerebrospinal fluid
Prospective Studies
Risk Factors
Cerebrospinal fluid
Cognitive impairment
Cortisol
Delirium
Hip fracture
Journal
Dementia and geriatric cognitive disorders
ISSN: 1421-9824
Titre abrégé: Dement Geriatr Cogn Disord
Pays: Switzerland
ID NLM: 9705200
Informations de publication
Date de publication:
2020
2020
Historique:
received:
27
09
2020
accepted:
10
11
2020
pubmed:
3
3
2021
medline:
21
10
2021
entrez:
2
3
2021
Statut:
ppublish
Résumé
Ageing, depression, and neurodegenerative disease are common risk factors for delirium in the elderly. These risk factors are associated with dysregulation of the hypothalamic-pituitary-adrenal axis, resulting in higher levels of cortisol under normal and stressed conditions and a slower return to baseline. We investigated whether elevated preoperative cerebrospinal fluid (CSF) cortisol levels are associated with the onset of postoperative delirium. In a prospective cohort study CSF samples were collected after cannulation for the introduction of spinal anesthesia of 75 patients aged 75 years and older admitted for surgical repair of acute hip fracture. Delirium was assessed with the confusion assessment method (CAM) and the Delirium Rating Scale-Revised-98 (DRS-R98). Because the CAM and DRS-R98 were available for time of admission and 5 postoperative days, we used generalized estimating equations and linear mixed modeling to examine the association between preoperative CSF cortisol levels and the onset of postoperative delirium. Mean age was 83.5 (SD 5.06) years, and prefracture cognitive decline was present in one-third of the patients (24 [33%]). Postoperative delirium developed in 27 (36%) patients. We found no association between preoperative CSF cortisol levels and onset or severity of postoperative delirium. These findings do not support the hypothesis that higher preoperative CSF cortisol levels are associated with the onset of postoperative delirium in elderly hip fracture patients.
Sections du résumé
BACKGROUND
Ageing, depression, and neurodegenerative disease are common risk factors for delirium in the elderly. These risk factors are associated with dysregulation of the hypothalamic-pituitary-adrenal axis, resulting in higher levels of cortisol under normal and stressed conditions and a slower return to baseline.
OBJECTIVES
We investigated whether elevated preoperative cerebrospinal fluid (CSF) cortisol levels are associated with the onset of postoperative delirium.
METHODS
In a prospective cohort study CSF samples were collected after cannulation for the introduction of spinal anesthesia of 75 patients aged 75 years and older admitted for surgical repair of acute hip fracture. Delirium was assessed with the confusion assessment method (CAM) and the Delirium Rating Scale-Revised-98 (DRS-R98). Because the CAM and DRS-R98 were available for time of admission and 5 postoperative days, we used generalized estimating equations and linear mixed modeling to examine the association between preoperative CSF cortisol levels and the onset of postoperative delirium.
RESULTS
Mean age was 83.5 (SD 5.06) years, and prefracture cognitive decline was present in one-third of the patients (24 [33%]). Postoperative delirium developed in 27 (36%) patients. We found no association between preoperative CSF cortisol levels and onset or severity of postoperative delirium.
CONCLUSIONS
These findings do not support the hypothesis that higher preoperative CSF cortisol levels are associated with the onset of postoperative delirium in elderly hip fracture patients.
Identifiants
pubmed: 33652441
pii: 000512984
doi: 10.1159/000512984
doi:
Substances chimiques
Hydrocortisone
WI4X0X7BPJ
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
604-610Subventions
Organisme : Medical Research Council
ID : G1001401
Pays : United Kingdom
Organisme : Medical Research Council
ID : G108/646
Pays : United Kingdom
Informations de copyright
© 2021 The Author(s) Published by S. Karger AG, Basel.