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Cape E, Hall RJ, van Munster BC, de Vries A, Howie SEM, Pearson A, Middleton SD, Gillies F, Armstrong IR, White TO, Cunningham C, de Rooij SE, MacLullich AMJ. Cerebrospinal fluid markers of neuroinflammation in delirium: a role for interleukin-1β in delirium after hip fracture. J Psychosom Res 2014; 77:219-25. [PMID: 25124807 PMCID: PMC4274366 DOI: 10.1016/j.jpsychores.2014.06.014] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 06/23/2014] [Accepted: 06/24/2014] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Exaggerated central nervous system (CNS) inflammatory responses to peripheral stressors may be implicated in delirium. This study hypothesised that the IL-1β family is involved in delirium, predicting increased levels of interleukin-1β (IL-1β) and decreased IL-1 receptor antagonist (IL-1ra) in the cerebrospinal fluid (CSF) of elderly patients with acute hip fracture. We also hypothesised that Glial Fibrillary Acidic Protein (GFAP) and interferon-γ (IFN-γ) would be increased, and insulin-like growth factor 1 (IGF-1) would be decreased. METHODS Participants with acute hip fracture aged >60 (N=43) were assessed for delirium before and 3-4 days after surgery. CSF samples were taken at induction of spinal anaesthesia. Enzyme-linked immunosorbent assays (ELISA) were used for protein concentrations. RESULTS Prevalent delirium was diagnosed in eight patients and incident delirium in 17 patients. CSF IL-1β was higher in patients with incident delirium compared to never delirium (incident delirium 1.74 pg/ml (1.02-1.74) vs. prevalent 0.84 pg/ml (0.49-1.57) vs. never 0.66 pg/ml (0-1.02), Kruskal-Wallis p=0.03). CSF:serum IL-1β ratios were higher in delirious than non-delirious patients. CSF IL-1ra was higher in prevalent delirium compared to incident delirium (prevalent delirium 70.75 pg/ml (65.63-73.01) vs. incident 31.06 pg/ml (28.12-35.15) vs. never 33.98 pg/ml (28.71-43.28), Kruskal-Wallis p=0.04). GFAP was not increased in delirium. IFN-γ and IGF-1 were below the detection limit in CSF. CONCLUSION This study provides novel evidence of CNS inflammation involving the IL-1β family in delirium and suggests a rise in CSF IL-1β early in delirium pathogenesis. Future larger CSF studies should examine the role of CNS inflammation in delirium and its sequelae.
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Affiliation(s)
- Eleanor Cape
- Edinburgh Delirium Research Group, University of Edinburgh, Edinburgh, Scotland, UK
| | - Roanna J Hall
- Edinburgh Delirium Research Group, University of Edinburgh, Edinburgh, Scotland, UK; Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, Scotland, UK; Department of Geriatrics, Western General Hospital, Edinburgh, Scotland, UK.
| | - Barbara C van Munster
- Department of Medicine, Amsterdam Delirium Study Group, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands; Department of Geriatrics, Gelre Hospitals, Apeldoorn, The Netherlands
| | | | - Sarah E M Howie
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, Scotland, UK
| | - Andrew Pearson
- Edinburgh Delirium Research Group, University of Edinburgh, Edinburgh, Scotland, UK
| | - Scott D Middleton
- Department of Trauma and Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK
| | - Fiona Gillies
- Edinburgh Delirium Research Group, University of Edinburgh, Edinburgh, Scotland, UK
| | - Ian R Armstrong
- Department of Anaesthetics, Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK
| | - Tim O White
- Department of Trauma and Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK
| | - Colm Cunningham
- School of Biochemistry and Immunology, Trinity College Dublin, Dublin, Ireland
| | - Sophia E de Rooij
- Department of Medicine, Amsterdam Delirium Study Group, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Alasdair M J MacLullich
- Edinburgh Delirium Research Group, University of Edinburgh, Edinburgh, Scotland, UK; Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, Scotland, UK
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