Background: Postoperative delirium in elderly people with hip fracture is associated with various adverse clinical outcomes. Nevertheless, the pathophysiological processes underpinning delirium have remained elusive. Objectives: The aim of this study was to explore the associations between delirium and its features and immune-inflammatory and blood gas biomarkers. Methods: In this prospective study, we examined 65 patients who underwent a hip fracture surgery and assessed the Confusion Assessment Method for the Intensive Care Unit, Richmond Agitation-Sedation Scale (RASS), and Delirium Rating Scale Revised-98 (DRS-R-98) before and during 4 days after the surgery. Complete blood count and venous blood gas markers were obtained at the same time points. Results: Delirium was observed in 19 patients and was accompanied by significantly increased pO₂, number of white blood cells, neutrophil percentage, and neutrophil/lymphocyte ratio, and lower mean platelet volume (MPV) after adjusting for age, central nervous system (CNS) disease, blood loss during surgery, sleep disorders, and body mass index. The severity of delirium was associated with lowered number of platelets and MPV. Psychomotor disorders were associated with lower bicarbonate levels. The requirement of physical restraint of the patients was predicted by increased percentages of neutrophils and lymphocytes. Prior CNS disease was together with these biomarkers a significant predictor of delirium and severity of delirium. Conclusion: Delirium and psychomotor disorders following hip fracture and surgery may be caused by immune-inflammatory and oxidative stress pathways probably attributable to an aseptic inflammatory process.
Dement Geriatr Cogn Disord

中文翻译：

---

老年髋部骨折手术患者谵妄的免疫、血细胞和血气生物标志物

背景：老年人髋部骨折术后谵妄与各种不良临床结果相关。然而，支持谵妄的病理生理过程仍然难以捉摸。目的：本研究的目的是探讨谵妄及其特征与免疫炎症和血气生物标志物之间的关联。方法：在这项前瞻性研究中，我们检查了 65 名接受髋部骨折手术的患者，并评估了重症监护病房的意识模糊评估方法、里士满躁动镇静量表 (RASS) 和谵妄评定量表修订版 98 (DRS-R- 98) 手术前和手术后 4 天期间。在同一时间点获得全血细胞计数和静脉血气标志物。结果：19 名患者出现谵妄，并伴有 pO ₂、白细胞数量、中性粒细胞百分比和中性粒细胞/淋巴细胞比率显着增加，以及在调整年龄、中枢神经系统 (CNS) 疾病后的平均血小板体积 (MPV) 降低、手术期间失血、睡眠障碍和体重指数。谵妄的严重程度与血小板和 MPV 数量减少有关。精神运动障碍与较低的碳酸氢盐水平有关。中性粒细胞和淋巴细胞百分比的增加预测了患者对身体约束的需求。先前的中枢神经系统疾病与这些生物标志物一起是谵妄和谵妄严重程度的重要预测因子。结论：髋部骨折和手术后的谵妄和精神运动障碍可能是由免疫炎症和氧化应激途径引起的，可能归因于无菌炎症过程。
老年痴呆症认知障碍