Background

Delirium is a common neuropsychiatric disorder associated with prolonged hospital stays, and increased morbidity and mortality. Diagnosis is frequently missed due to varying disease presentation and lack of standardized testing. We examined biomarkers as diagnostic or prognostic indicators of delirium, and provide a rational basis for future studies.

Method

Systematic review of literature published between Jan 2000 and June 2019. Searches included: PubMed; Web of Science; CINAHL; EMBASE; COCHRANE and Medline. Additional studies were identified by searching bibliographies of eligible articles.

Results

2082 relevant papers were identified from all sources. Seventy-three met the inclusion criteria, all of which were observational. These assessed a range of fourteen biomarkers. All papers included were in the English language. Assessment methods varied between studies, including: DSM criteria; Confusion Assessment Method (CAM) or CAM-Intensive Care Unit (ICU). Delirium severity was measured using the Delirium Rating Scale (DRS). Delirium was secondary to post-operative dysfunction or acute medical conditions.

Conclusion

Evidence does not currently support the use of any one biomarker. However, certain markers were associated with promising results and may warrant evaluation in future studies. Heterogeneity across study methods may have contributed to inconclusive results, and more clarity may arise from standardization of methods of clinical assessment. Adjusting for comorbidities may improve understanding of the pathophysiology of delirium, in particular the role of confounders such as inflammation, cognitive disorders and surgical trauma. Future research may also benefit from inclusion of other diagnostic modalities such as EEG as well as analysis of genetic or epigenetic factors.

中文翻译：

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谵妄生物标志物：系统评价

背景

谵妄是一种常见的神经精神疾病，与住院时间延长、发病率和死亡率增加有关。由于不同的疾病表现和缺乏标准化测试，经常会错过诊断。我们检查了生物标志物作为谵妄的诊断或预后指标，并为未来的研究提供了合理的基础。

方法

对 2000 年 1 月至 2019 年 6 月期间发表的文献进行系统审查。搜索包括：PubMed；科学网；CINAHL; EMBASE; COCHRANE 和 Medline。通过搜索符合条件的文章的参考书目确定了其他研究。

结果

从所有来源确定了 2082 篇相关论文。73 人符合纳入标准，所有这些都是观察性的。这些评估了一系列十四种生物标志物。收录的所有论文都是英文的。评估方法因研究而异，包括： DSM 标准；意识模糊评估方法 (CAM) 或 CAM-重症监护室 (ICU)。使用谵妄评定量表 (DRS) 测量谵妄严重程度。谵妄继发于术后功能障碍或急性医疗状况。

结论

目前没有证据支持使用任何一种生物标志物。然而，某些标记与有希望的结果相关，可能需要在未来的研究中进行评估。研究方法的异质性可能导致结果不确定，临床评估方法的标准化可能会带来更多的清晰度。调整合并症可能会提高对谵妄病理生理学的理解，尤其是炎症、认知障碍和手术创伤等混杂因素的作用。未来的研究也可能受益于纳入其他诊断方式，如 EEG 以及遗传或表观遗传因素的分析。