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Insulin-like growth factor-1 and delirium in critically ill mechanically ventilated patients: a preliminary investigation

Published online by Cambridge University Press:  04 February 2011

A. Morandi ,
M. L. Gunther ,
P. P. Pandharipande ,
J. C. Jackson ,
J. L. Thompson ,
A. K. Shintani ,
E. W. Ely  and
T. D. Girard
A. Morandi*
Affiliation:
Center for Quality of Aging, Vanderbilt University School of Medicine, Nashville, Tennessee, USA Center for Health Services Research, Vanderbilt University School of Medicine, Nashville, Tennessee, USA Division of Allergy, Pulmonary and Critical Care Medicine in the Department of Medicine at the Vanderbilt University School of Medicine, Nashville, Tennessee, USA
M. L. Gunther
Affiliation:
Center for Quality of Aging, Vanderbilt University School of Medicine, Nashville, Tennessee, USA Center for Health Services Research, Vanderbilt University School of Medicine, Nashville, Tennessee, USA Vanderbilt University Institute of Imaging Sciences (VUIIS), Nashville, Tennessee, USA Department of Psychiatry, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
P. P. Pandharipande
Affiliation:
Department of Anesthesiology, Division of Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA Anesthesia Service, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, Tennessee, USA
J. C. Jackson
Affiliation:
Center for Quality of Aging, Vanderbilt University School of Medicine, Nashville, Tennessee, USA Department of Psychiatry, Vanderbilt University School of Medicine, Nashville, Tennessee, USA Research Service, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, Tennessee, USA
J. L. Thompson
Affiliation:
Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
A. K. Shintani
Affiliation:
Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
E. W. Ely
Affiliation:
Center for Quality of Aging, Vanderbilt University School of Medicine, Nashville, Tennessee, USA Center for Health Services Research, Vanderbilt University School of Medicine, Nashville, Tennessee, USA Division of Allergy, Pulmonary and Critical Care Medicine in the Department of Medicine at the Vanderbilt University School of Medicine, Nashville, Tennessee, USA Geriatric Research, Education and Clinical Center (GRECC) Service, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, Tennessee, USA
T. D. Girard
Affiliation:
Center for Quality of Aging, Vanderbilt University School of Medicine, Nashville, Tennessee, USA Center for Health Services Research, Vanderbilt University School of Medicine, Nashville, Tennessee, USA Division of Allergy, Pulmonary and Critical Care Medicine in the Department of Medicine at the Vanderbilt University School of Medicine, Nashville, Tennessee, USA Geriatric Research, Education and Clinical Center (GRECC) Service, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, Tennessee, USA
*
Correspondence should be addressed to: Alessandro Morandi, MD, 1211 21st Avenue South Suite 6100, Nashville, TN 37212, USA Phone: +1 (615) 936–5068; Fax: +1 (615) 936–1269. Email: alessandro.morandi@vanderbilt.edu.
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Abstract

Background: Delirium occurs frequently in the intensive care unit (ICU), but its pathophysiology is still unclear. Low levels of insulin-like growth factor 1 (IGF-1), a hormone with neuroprotective properties, have been associated with delirium in some non-ICU studies, but this relationship has not been examined in the ICU. We sought to test the hypothesis that low IGF-1 concentrations are associated with delirium during critical illness.

Methods: Mechanically ventilated medical ICU patients were prospectively enrolled, and blood was collected after enrollment for measurement of IGF-1 using radioimmunometric assay. Delirium and coma were identified daily using the Confusion Assessment Method for the ICU and the Richmond Agitation-Sedation Scale, respectively. The association between IGF-1 and delirium was evaluated with logistic regression. In addition, the association between IGF-1 and duration of normal mental state, measured as days alive without delirium or coma, was assessed using multiple linear regression.

Results: Among 110 patients, the median age was 65 years (IQR, 52–75) and APACHE II was 27 (IQR, 22 –32). IGF-1 levels were not a risk factor for delirium on the day after IGF-1 measurement (p = 0.97), at which time 65% of the assessable patients were delirious. No significant association was found between IGF-1 levels and duration of normal mental state (p = 0.23).

Conclusions: This pilot study, the first to investigate IGF-1 and delirium in critically ill patients, found no association between IGF-1 and delirium. Future studies including serial measurements of IGF-1 and IGF-1 binding proteins are needed to determine whether this hormone has a role in delirium during critical illness.

Keywords

insulin-like growth factor-1deliriumacute brain dysfunctioncomacritical illnessintensive care unitelderly
Type
Research Article
Information
International Psychogeriatrics , Volume 23 , Issue 7 , September 2011 , pp. 1175 - 1181
Copyright
Copyright © International Psychogeriatric Association 2011

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