The Correlation Of Plasma Leptin Level And Delirium In Critically ? Patients

Background:Delirium is a serious and commonly observed clinical syndrome in critically ill patients.In patients in the intensive care unit(ICU),delirium is not only has a high incidence,but olso the occurrence of delirium will lead to multiple negative outcomes,including longer hospital stays,increased mortality.However,the pathophysiology of delirium remains incompletely understood.For these reasons,it is very important to explore the potential pathophysiologic mechanisms underlying the occurrence of delirium in critically ill patients.Leptin is a circulating protein mostly secreted from white adipose tissue.In addition to playing a role in energy regulation,leptin may take part in the process of inflammatory reaction.Furthermore,leptin can worsen learning and memory performance and has neuroprotective effects.These functions of leptin raise the possibility that it might be involved in the development of delirium.Recent studies have reported that leptin levels were significantly lower in non-ICU patients with delirium.However,the relationship between plasma leptin level and the occurrence of delirium in critically ill patients has not been fully demonstrated.Therefore,it is valuable to examine the relationship between plasma leptin level at ICU entry and the subsequent development of delirium in critically ill patients.Objective:To explore plasma leptin level at ICU entry can predict the occurrence of delirium in critically ill patients,and understand the relation between the occurrence of delirium and the outcomes of length of ICU stay and 28-day mortality in critically ill patients.Methods:601 patients were screened for potential eligibility and a total of 336 critically ill patients admitted to ICU into a delirium group(n=102)and non-delirium group(n=234)based on whether delirium occurred during their stay at the ICU.The plasma concentration of leptin at ICU entry was determined by enzyme-linked immunosorbent assay and compare in the two groups.At the same time,the association between leptin level at ICU entry and the development of delirium was assessed using a logistic regression model with calculation of the odds ratio(OR)and 95%confidence interval(CI).Results:Delirium occurred in 30.4%(102/336)of patients.Patients who developed delirium showed significantly lower leptin level at ICU entry than those who did not(6.1±3,2 vs.9.2±5.9 ng/ml;P<0.001).Low plasma leptin level at ICU entry was associated with subsequent occurrence of delirium(OR,0.865;95%CI,0.802-0.934;P<0.001).Other independent risk factors for delirium included increasing age(OR,1.050;95%CI,1.020-1.080;P=0.001)and Acute Physiology and Chronic Health Evaluation-II(APACHE-?)score(OR,1.148;95%CI,1.092-1.208;P<0.001).Patients who developed delirium had a prolonged duration of ICU stay and higher mortality.Conclusion:Low plasma leptin level at ICU entry was associated with the occurrence of delirium in critically ill patients.