Or postoperative status and day of blood withdrawal were all associated

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  • Or postoperative status and day of blood withdrawal were all associated
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    Or postoperative status and day of blood withdrawal were all associated with S100B levels. The effect of fracture and surgery and the time course were expected covariables based on the literature[31]. Although the group of delirious patients with known subtype was small, the hyperactive type of delirium was the most common subtype of delirium in our study, similar to what has been described by others[32]. Moreover, selection bias seems improbable since the delirious patients included in this analysis did not differ in associated factors with S100B and levels of NSE and S100B compared to the delirious patients without knownTable 3: Values of NSE (ng/mL) and S100B (g/L) and DRS-R-98 scores during delirium in different subtypes.*Hyperactive NSE ?number N ( ) > 12.5 Mean (SD) S100B ?number N ( ) > 0.10 Median (IQR) DRS-R-98 11 4 (36) 12.2 (3.8) 17 13 (77) 0.17 (0.10?.21)Mixed 8 4 (50) 14.3 (5.5) 12 11 (92) 0.23 (0.11?.32)Hypoactive 4 1 (25) 11.0 (2.8) 4 3 (75) 0.12 (0.09?.54)p-value0.68 0.0.54 0.43 0.IQR: inter-quartile-range; DRS-R-98: Delirium Rating Scale-R-98. *Subtype is specified in 34 delirious patients; one patient did not meet the criteria of any of the subtypes; specification of the subtype was missing for 23 delirious patients; of five patients no blood sample was taken during delirium. DRS-R-98 score is specified in 29 of the patients with known subtype.Page 5 of(page number not for citation purposes)BMC Neurology 2009, 9:http://www.biomedcentral.com/1471-2377/9/subtype. Because this still could have introduced a bias, future studies are needed to confirm the lack of association between subtypes and NSE or S100B. A limitation of our study is that the NSE and S100B values were measured from peripheral blood and may not necessarily correspond to values in the brain. Under normal conditions serum NSE and NSE in cerebrospinal fluid (CSF) show no significant correlation, whereas serum S100B content is lower than that in Gemcitabine (hydrochloride) CSF[11,33]. We are not aware of studies that determined NSE and S100B in both CSF and blood among patients with cognitive deficits such as delirium. A second limitation of our study is that only 120 of the 183 (66 ) patients consented to multiple blood withdrawals. Although the excluded patients were 2.5 yrs. younger it is unlikely that this small difference would affect the protein levels. Our results showing elevated S100B levels in delirious patients are in line with former studies [13-15]. Studies looking at postoperative cognitive deficit (POCD) and S100B after surgery show however contradicting results, with no relation between S100B and cognitive performance after PubMed ID:https://www.ncbi.nlm.nih.gov/pubmed/16989806 cardiac surgery at discharge [17], a questionable relation directly after cardiac surgery [34], but higher levels of S100B in patients with POCD after non-cardiac surgery[18]. The definition of POCD remains controversial, but it seems likely that delirium and short-term POCD are on a continuum of postoperative cognitive brain disorders[35]. Seeing delirium as subset of POCD, our results of NSE correspond to former studies that found no association between NSE and POCD at discharge from hospital after non-cardiac surgery[18]. Maybe NSE is released only in cases of severe brain damage, such as stroke, after resuscitation or neurologically complicated surgery[18]. Importantly, S100B is a marker of cerebral damage and/or reduced integrity of the blood brain barrier. In stroke, global hypoxia and traumatic brain injury a positive correlation between S100B.

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