Age and Ageing Advance Access originally published online on May 30, 2007
Age and Ageing 2007 36(4):473; doi:10.1093/ageing/afm060
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C-reactive protein and delirium in acute ill elderly patients
SIR—We have read with great interest the research letter by MacDonald et al. [1] and the related editorial by George et al. [2] recently published in Age and Ageing on the relation between C-reactive protein (C-RP) and delirium.
We would like to contribute to this topic with data obtained in a recently developed medical sub-intensive care unit (SICU) for elderly patients. Our model is developed to meet the needs of critically ill elderly medical patients who do not require global intensive care but a higher level of care than that provided in a general ward. The technological equipment of the SICU allows non-invasive monitoring of vital signs and/or intensive interventions. From January 2004 to December 2006, 1,369 patients aged 
60 years were admitted to SICU, mean age 77.2 ± 11 years, males 51%, Barthel index (BI) before admission 71.4 ± 31.3, BI at admission 33.0 ± 35.1, BI at discharge 51.6 ± 38.3, Mini Mental State Examination (MMSE) at discharge 20.7 ± 9.8, Charlson Index 6.0 ± 2.1, APACHE-II score 14.2 ± 6.3, APACHE-APS subscore 8.6 ± 5.9, number of drugs 7.4 ± 3.1 and length of stay in hospital 6.5 ± 5 days. Patients were assessed for delirium at admission and three times a day (until remission from delirium), using the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) [3].
Three hundred and one (21.5%) patients had delirium; 132 (9.4%) were cases of prevalent and 169 (12.1%) of incident delirium. Mean MMSE-score was 13.06 ± 10.2, was 16.7 ± 8.5 and 9.3 ± 10.5 in the total number of subjects affected by delirium and in those affected by incident and prevalent delirium respectively. Moreover prevalence of dementia was 39.7%, 15.3% and 24.3% for total, incident and prevalent delirium respectively. Mean C-RP values were 8.8 ± 9.8, 7.85 ± 9.6 and 9.6 ± 9.9 for total, incident and prevalent delirium respectively. Furthermore patients with incident delirium showed better functional status than those with prevalent, as assessed with BI 2 weeks before admission (76.02 ± 29.07 vs 61.6 ± 31.6), at admission (16.81 ± 24.9 vs 7.8 ± 18.9) and at discharge (34.9 ± 32.1 vs 14.9 ± 26.7). Also the severity of illness was found to be higher in prevalent delirium; in fact Acute-Physiology-Score (APS) was 11.6 ± 6.8, 9.4 ± 5.5 and 13.23 ± 7.3 for total, incident and prevalent delirium respectively. Comorbidity (Charlson Index score) had the same trend: 6.8 ± 1.9, 6.5 ± 1.8 and 7 ± 1.8 for total, incident and prevalent delirium respectively.
Data show that prevalent delirium, characterised by a worse health status, high disability, and, as previously reported, by a worse prognosis [4, 5] is associated with higher C-RP plasma levels, in comparison with incident delirium. This fact support the hypothesis that inflammation mediates different degree of vulnerability to delirium in older people.
Department of Internal Medicine and Geriatrics, Poliambulanza Hospital, Brescia and Geriatric Research Group, via Romanino 1, 25122 Brescia, Italy
* To whom correspondence should be addressed Email: alessandromorandi{at}yahoo.com
References
- MacDonald A, Adamis D, Treloar A, Martin F. C-reactive protein levels predict the incidence of delirium and recovery from it. Age Ageing (2007) 36:222–5.
[Free Full Text] - George J, Mukaetova-Ladinska EB. Delirium and C-reactive protein. Age Ageing (2007) 36:115–6.
[Free Full Text] - Ely EW, Margolin R, Francis J, et al. Evaluation of delirium in critically ill patients: Validation of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Crit Care Med (2001) 29:1370–9.[CrossRef][ISI][Medline]
- Ranhoff A, Rozzini R, Sabatini T, et al. Delirium in a sub-intensive care unit for the elderly: occurrence and risk factors. Aging Clin Exp Res (2006) 18:440–5.[ISI][Medline]
- Siddiqi N, House O, Holmes JD. Occurrence and outcome of delirium in medical in-patients: a systematic literature review. Age Ageing (2006) 35:350–64.
[Abstract/Free Full Text]
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