Chemokines in ICU Delirium: An Exploratory Study
Ryan J Smith1, Alejandro A Rabinstein2, Rodrigo Cartin-Ceba3,4
1Mayo Clinic School of Graduate Medical Education, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
Critical Care Explorations
|July 11, 2022
Summary
Inflammation, particularly elevated C-C motif ligand 2 (CCL2) levels, is linked to intensive care unit (ICU) delirium. This suggests CCL2 may play a role in delirium development, requiring further study.
Area of Science:
- Critical Care Medicine
- Neuroscience
- Immunology
Background:
- Delirium pathophysiology is complex and not fully understood.
- Inflammation is a suspected contributor to delirium, impacting the blood-brain barrier and neuroinflammation.
- The roles of hypotension and systemic inflammation in septic shock-associated ICU delirium are unclear.
Purpose of the Study:
- To investigate the association between specific inflammatory chemokines and the development of delirium in critically ill patients.
- To determine if C-C motif ligand 2 (CCL2) is independently associated with ICU delirium.
Main Methods:
- Prospective exploratory study in a multidisciplinary ICU.
- Enrolled critically ill adult patients admitted to the ICU.
- Measured serum chemokine levels (CCL2, CCL3, CXCL1, CXCL10, IL-8) within 12 hours of admission.
- Assessed delirium using the Confusion Assessment Method for the ICU tool.
- Performed univariate and multivariate analyses to identify associations with delirium.
Main Results:
- 34.5% of patients (41/119) developed ICU delirium.
- All measured chemokines were associated with delirium on univariate analysis.
- C-C motif ligand 2 (CCL2) was the only chemokine independently associated with delirium on multivariable analysis.
- The association between higher CCL2 levels and delirium remained significant after controlling for numerous clinical factors.
Conclusions:
- Elevated serum CCL2 levels are independently associated with the development of ICU delirium.
- CCL2 may play a significant role in the pathophysiology of delirium.
- Further research is warranted to explore the relationship between CCL2 and delirium.
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