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The association between C-reactive protein and delirium in 710 acute elderly hospital admissions

Published online by Cambridge University Press:  24 January 2014

C.W. Ritchie ,
T.H. Newman ,
B. Leurent  and
E.L. Sampson
C.W. Ritchie*
Affiliation:
Centre for Mental Health, Imperial College London, London, UK
T.H. Newman
Affiliation:
Centre for Mental Health, Imperial College London, London, UK
B. Leurent
Affiliation:
Marie Curie Palliative Care Research Unit, UCL Mental Health Sciences Unit, University College Medical School, Charles Bell House, London, UK
E.L. Sampson
Affiliation:
Marie Curie Palliative Care Research Unit, UCL Mental Health Sciences Unit, University College Medical School, Charles Bell House, London, UK Barnet Enfield and Haringey Mental Health Trust, St Ann's Hospital, St Ann's Road, London, UK
*
Correspondence should be addressed to: Dr Craig W Ritchie, Centre for Mental Health, Imperial College London, Claybrook Centre, 37, Claybrook Road, Hammersmith, London W6 8LN, UK. Phone: +44-0207-430-1630. Email: [email protected].
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Abstract

Background:

Delirium is a common neuropsychiatric syndrome associated with poor outcomes. Evidence supports a neuroinflammatory etiology, but the role of the inflammatory marker C-reactive protein (C-RP) remains unclear. We investigated the relationship between C-RP and delirium and its severity as well as interaction with medical diagnosis.

Methods:

From an existing database (710 patients over 70 years old admitted to a Medical Acute Admissions Unit) we analyzed data which included C-RP levels, delirium (using the Confusion Assessment Method), and other clinical and demographic factors. Primary diagnoses were grouped (cardiovascular, musculoskeletal, infection, metabolic, and other).

Results:

There was a strong association between elevated C-RP and delirium (t = 5.09; p < 0.001), independent of other potential risk factors for delirium (odds ratio (OR) = 1.32 (95% CI: 1.10–1.58) p = 0.003). There was no significant association between C-RP and delirium severity, and between C-RP and delirium in the populations with cardiovascular disease, infection upon admission, or from the metabolic group despite an OR of 2.24 (95% CI: 0.92–5.45). There was an association in the musculoskeletal group (OR 2.19 (95% CI: 1.19–4.02)).

Conclusions: There is an association between elevated C-RP and delirium. This is strongest in patients admitted with musculoskeletal disease but not in others, implying that C-RP is involved in the genesis of delirium in musculoskeletal disease, but that other factors or processes may be more important in those with cardiovascular disease or infection.

Keywords

deliriumorganic mental disordersbiomarkerspsychogeriatricsneuropsychiatryinflammationC-reactive protein
Type
Research Article
Information
International Psychogeriatrics , Volume 26 , Issue 5 , May 2014 , pp. 717 - 724
Copyright
Copyright © International Psychogeriatric Association 2014 

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