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Raised IL-2 and TNF-α concentrations are associated with postoperative delirium in patients undergoing coronary-artery bypass graft surgery

Published online by Cambridge University Press:  17 December 2013

Jakub Kazmierski ,
Andrzej Banys ,
Joanna Latek ,
Julius Bourke  and
Ryszard Jaszewski
Jakub Kazmierski*
Affiliation:
Department of Old Age Psychiatry and Psychotic Disorders, Medical University of Lodz, Lodz, Poland
Andrzej Banys
Affiliation:
Department of Anaesthesiology and Intensive Cardiologic Care, 1st Chair of Cardiology and Cardiac Surgery, Medical University of Lodz, Lodz, Poland
Joanna Latek
Affiliation:
Central Veterans Hospital, Lodz, Poland
Julius Bourke
Affiliation:
The Centre for Psychiatry at The Wolfson Institute for Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
Ryszard Jaszewski
Affiliation:
Department of Cardiac Surgery, 1st Chair of Cardiology and Cardiac Surgery, Medical University of Lodz, Lodz, Poland
*
Correspondence should be addressed to: Jakub Kazmierski, MD, PhD, Department of Old Age Psychiatry and Psychotic Disorders, Medical University of Lodz, Czechoslowacka 8/10, 92-216 Lodz, Poland. Phone: +48 42 675 73 72; Fax: +48 42 675 77 29. Email: jakub.kazmierski@umed.lodz.pl.
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Abstract

Background:

The knowledge base regarding the pathogenesis of postoperative delirium is limited. The primary aim of this study is to investigate whether increased levels of IL-2 and TNF-α are associated with delirium in patients who underwent coronary-artery bypass graft (CABG) surgery with cardiopulmonary bypass (CPB). The secondary aim is to establish whether any association between raised cytokine levels and delirium is related to surgical and anesthetic procedures or mediated by pre-existing conditions associated with raised cytokine levels, such as major depressive disorder (MDD), cognitive impairment, or aging.

Methods:

Patients were examined and screened for MDD and cognitive impairment one day preoperatively, using the Mini International Neuropsychiatric Interview and The Montreal Cognitive Assessment and Trail Making Test Part B. Blood samples were collected postoperatively for cytokine levels.

Results:

Postoperative delirium screening was found positive in 36% (41 of 113) of patients. A multivariate logistic regression revealed that an increased concentration of pro-inflammatory cytokines is associated with delirium, and related to advancing age, preoperative cognitive decline of participants, and duration of CPB. According to receiver operating characteristic analysis, the most optimal cut-off for IL-2 and TNF-α concentrations in predicting the development of delirium were 907.5 U/ml and 10.95 pg/ml, respectively.

Conclusions:

The present study suggests that raised postoperative cytokine concentrations are associated with delirium after CABG surgery. Postoperative monitoring of pro-inflammatory markers combined with regular surveillance may be helpful in the early detection of postoperative delirium in this patient group.

Keywords

deliriumcoronary-artery bypass graftingcardiac surgerycytokinesinterleukins
Type
Research Article
Information
International Psychogeriatrics , Volume 26 , Issue 5 , May 2014 , pp. 845 - 855
Copyright
Copyright © International Psychogeriatric Association 2013 

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