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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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References

Aberg, M. A., Aberg, N. D., Hedbacker, H., Oscarsson, J. and Eriksson, P. S. (2000). Peripheral infusion of IGF-I selectively induces neurogenesis in the adult rat hippocampus. Journal of Neuroscience, 20, 2896–2903.CrossRefGoogle ScholarPubMed
Adamis, D., Treloar, A., Martin, F. C., Gregson, N., Hamilton, G. and Macdonald, A. J. (2007). APOE and cytokines as biological markers for recovery of prevalent delirium in elderly medical inpatients. International Journal of Geriatric Psychiatry, 22, 688–694.CrossRefGoogle ScholarPubMed
Adamis, D. et al. (2009). Cytokines and IGF-I in delirious and non-delirious acutely ill older medical inpatients. Age and Ageing, 38, 326–332.CrossRefGoogle ScholarPubMed
Angus, D. C., Kelley, M. A., Schmitz, R. J., White, A. and Popovich, J. Jr. (2000). Caring for the critically ill patient: current and projected workforce requirements for care of the critically ill and patients with pulmonary disease. Can we meet the requirements of an aging population? JAMA, 284, 2762–2770.CrossRefGoogle ScholarPubMed
Ashare, A., Nymon, A. B., Doerschug, K. C., Morrison, J. M., Monick, M. M. and Hunninghake, G. W. (2008). Insulin-like growth factor-1 improves survival in sepsis via enhanced hepatic bacterial clearance. American Journal of Respiratory and Critical Care Medicine, 178, 149–157.CrossRefGoogle ScholarPubMed
Basi, S. et al. (2005). Insulin resistance in critically ill patients with acute renal failure. American Journal of Physiology: Renal Physiology, 289, F259–F264.Google ScholarPubMed
Baxter, R. C., Martin, J. L. and Beniac, V. A. (1989). High molecular weight insulin-like growth factor binding protein complex: purification and properties of the acid-labile subunit from human serum. Journal of Biological Chemistry, 264, 11843–11848.CrossRefGoogle ScholarPubMed
Baxter, R. C., Hawker, F. H., To, C., Stewart, P. M. and Holman, S. R. (1998). Thirty-day monitoring of insulin-like growth factors and their binding proteins in intensive care unit patients. Growth Hormone IGF Research, 8, 455–463.CrossRefGoogle ScholarPubMed
Blum, W. F. and Breier, B. H. (1994). Radioimmunoassays for IGFs and IGFBPs. Growth Regulation, 4 (Suppl. 1), 11–19.Google ScholarPubMed
Boulware, S. D., Tamborlane, W. V., Rennert, N. J., Gesundheit, N. and Sherwin, R. S. (1994). Comparison of the metabolic effects of recombinant human insulin-like growth factor-I and insulin: dose-response relationships in healthy young and middle-aged adults. Journal of Clinical Investigation, 93, 1131–1139.CrossRefGoogle Scholar
Brooker, G. J., Kalloniatis, M., Russo, V. C., Murphy, M., Werther, G. A. and Bartlett, P. F. (2000). Endogenous IGF-1 regulates the neuronal differentiation of adult stem cells. Journal of Neuroscience Research, 59, 332–341.3.0.CO;2-2>CrossRefGoogle ScholarPubMed
Ely, E. W. et al. (2001). Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). JAMA, 286, 2703–2710.CrossRefGoogle ScholarPubMed
Girard, T. D. et al. (2008a). Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled Trial): a randomised controlled trial. Lancet, 371, 126–134.CrossRefGoogle Scholar
Girard, T. D., Pandharipande, P. P. and Ely, E. W. (2008b). Delirium in the intensive care unit. Critical Care, 12 (Suppl. 3), S3.CrossRefGoogle ScholarPubMed
Girard, T. D. et al. (2010). Delirium as a predictor of long-term cognitive impairment in survivors of critical illness. Critical Care Medicine, 38, 1513–1520.CrossRefGoogle ScholarPubMed
Gunther, M. L., Morandi, A. and Ely, E. W. (2008). Pathophysiology of delirium in the intensive care unit. Critical Care Clinics, 24, 45–65.CrossRefGoogle ScholarPubMed
Inouye, S. K. and Ferrucci, L. (2006). Elucidating the pathophysiology of delirium and the interrelationship of delirium and dementia. Journal of Gerontology, A: Biological Science Medical Science, 61, 1277–1280.Google ScholarPubMed
Jorm, A. F. (1994). A short form of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE): development and cross-validation. Psychological Medicine, 24, 145–153.CrossRefGoogle Scholar
Katz, S., Ford, A. B., Moskowitz, R. W., Jackson, B. A. and Jaffe, M. W. (1963). Studies of illness in the aged. The index of ADL: a standardized measure of biological and psychological function. JAMA, 185, 914–919.CrossRefGoogle Scholar
Knaus, W. A., Draper, E. A., Wagner, D. P. and Zimmerman, J. E. (1985). APACHE II: a severity of disease classification system. Critical Care Medicine, 13, 818–829.CrossRefGoogle ScholarPubMed
Landi, F. et al. (2007). Free insulin-like growth factor-I and cognitive function in older persons living in community. Growth Hormone and IGF-1 Research, 17, 58–66.CrossRefGoogle ScholarPubMed
Lemstra, A. W., Kalisvaart, K. J., Vreeswijk, R., van Gool, W. A. and Eikelenboom, P. (2008). Pre-operative inflammatory markers and the risk of postoperative delirium in elderly patients. International Journal of Geriatric Psychiatry, 23, 943–948.CrossRefGoogle ScholarPubMed
Levy, M. M. et al. (2003). 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Critical Care Medicine, 31, 1250–1256.CrossRefGoogle ScholarPubMed
Pandharipande, P. P. et al. (2007). Effect of sedation with dexmedetomidine vs lorazepam on acute brain dysfunction in mechanically ventilated patients: the MENDS randomized controlled trial. JAMA, 298, 2644–2653.CrossRefGoogle Scholar
Pfeffer, R. I., Kurosaki, T. T., Harrah, C. H. Jr., Chance, J. M. and Filos, S. (1982). Measurement of functional activities in older adults in the community. Journal of Gerontology, 37, 323–329.CrossRefGoogle ScholarPubMed
Pisani, M. A., Kong, S. Y., Kasl, S. V., Murphy, T. E., Araujo, K. L. and van Ness, P. H. (2009). Days of delirium are associated with 1-year mortality in an older intensive care unit population. American Journal of Respiratory and Critical Care Medicine, 180, 1092–1097.CrossRefGoogle Scholar
Reinhardt, R. R. and Bondy, C. A. (1994). Insulin-like growth factors cross the blood-brain barrier. Endocrinology, 135, 1753–1761.CrossRefGoogle ScholarPubMed
Sessler, C. N. et al. (2002). The Richmond Agitation-Sedation Scale: validity and reliability in adult intensive care unit patients. American Journal of Respiratory and Critical Care Medicine, 166, 1338–1344.CrossRefGoogle ScholarPubMed
Timmins, A. C. et al. (1996). Critical illness is associated with low circulating concentrations of insulin-like growth factors-I and -II, alterations in insulin-like growth factor binding proteins, and induction of an insulin-like growth factor binding protein 3 protease. Critical Care Medicine, 24, 1460–1466.CrossRefGoogle ScholarPubMed
Trejo, J. L., Carro, E., Garcia-Galloway, E. and Torres-Aleman, I. (2004). Role of insulin-like growth factor I signaling in neurodegenerative diseases. Journal of Molecular Medicine, 82, 156–162.CrossRefGoogle ScholarPubMed
Wilson, K., Broadhurst, C., Diver, M., Jackson, M. and Mottram, P. (2005). Plasma insulin growth factor-1 and incident delirium in older people. International Journal of Geriatric Psychiatry, 20, 154–159.CrossRefGoogle ScholarPubMed
Zenobi, P. D., Graf, S., Ursprung, H. and Froesch, E. R. (1992). Effects of insulin-like growth factor-I on glucose tolerance, insulin levels, and insulin secretion. Journal of Clinical Investigation, 89, 1908–1913.CrossRefGoogle ScholarPubMed