Role of CRP, TNF-α, and IGF-1 in delirium pathophysiology/Deliryum patofizyolojisinde CRP, TNF-α ve IGF-1'in rolu

Introduction: Delirium is a common and life-threatening neuropsychiatric syndrome. Diagnosing delirium can be challenging, which increases mortality and mortality rates and health care costs. The biologic model of delirium is not definite yet, but evidence supports a cholinergic deficiency model. Delirium may be the result of processes and drugs that trespass a compromised blood-brain barrier. We aimed to evaluate the possible diagnostic utilization and the role of certain biomarkers, such as C- reactive protein (CRP), tumor necrosis factor-alpha (TNF-α), and insulin like growth factor-1 (IGF-1), in delirium etiology. Methods: A total of 93 inpatients that planned to undergo cardiovascular surgery were informed; 35 of them completed the study. Medical history and current cognitive status were evaluated pre-operatively. Participants were followed using Delirium Rating Scale-Revised-98 Turkish (DRS-R98-T) for delirium symptoms, and blood samples were collected post-operatively. Results: Delirium was developed more in participants who had worse pre-operative cognitive status. Also, low pre-operative IGF-1 levels were detected in the delirium group. Pre-operative CRP and TNF-α levels were not different between groups. Conclusion: Low IGF-1 levels can be used to predict delirium after surgery. However, the complex nature of cytokines and delirium itself make it difficult to utilize cytokines to predict delirium instead of psychometric tools. (Archives of Neuropsychiatry 2014; 51:376-382) Key words: Delirium, CRP TNF-α, IGF-1, DRS-R98-T Giris: Deliryum yaygin ve hayati tehdit eden noropsikiyatrik bir sendromdur. Deliryum tanisinin konulmasinda yasanan sorunlar morbidite ve mortalite oranlariyla birlikte hasta bakim maliyetlerini de artirmaktadir. Deliryumun biyolojik modelinin aciklikla ortaya konamamis olmasina ragmen eldeki kanitlar kolinerjik eksiklik modelini desteklemektedir. Deliryum kan beyin bariyerini gecen ilaclarin ve bazi sureclerin bir yansimasi olabilir. Bu calismada deliryumda kolinerjik eksiklik modeli esas alinarak C-reaktif protein (CRP), tumor nekroz faktor-alfa (TNF-α) ve insulin benzeri buyume hormonu- 1'in (IGF-1) deliryum etiyolojisindeki rollerinin ve soz konusu belirteclerin tanisal kullanim olasiliklarinin belirlenmesi amaclanmistir. Yontem: Calismaya kardiyovaskuler cerrahi planlanan 93 hasta alinmis, 35 hasta calismayi tamamlamistir. Katilimcilarin ameliyat oncesinde tibbi durumlari hakkinda bilgi toplanmis, mini mental test ve saat c