Impaired glucose utilization in the brain of patients with delirium following hip fracture

谵妄 酮体 医学 内科学 碳水化合物代谢 髋部骨折 胃肠病学 新陈代谢 内分泌学 麻醉 重症监护医学 骨质疏松症
作者
Irit Titlestad,Leiv Otto Watne,Gideon A. Caplan,Adrian McCann,Per Magne Ueland,Bjørn Erik Neerland,Marius Myrstad,Nathalie Bodd Halaas,Christian Pollmann,Kristi Henjum,Anette Hylen Ranhoff,Lene Bergendal Solberg,Wender Figved,C Cunningham,Lasse Melvær Giil
出处
期刊:Brain [Oxford University Press]
卷期号:147 (1): 215-223
标识
DOI:10.1093/brain/awad296
摘要

Abstract Alterations in brain energy metabolism have long been proposed as one of several neurobiological processes contributing to delirium. This is supported by previous findings of altered CSF lactate and neuron-specific enolase concentrations and decreased glucose uptake on brain-PET in patients with delirium. Despite this, there are limited data on metabolic alterations found in CSF samples, and targeted metabolic profiling of CSF metabolites involved in energy metabolism has not been performed. The aim of the study was to investigate whether metabolites related to energy metabolism in the serum and CSF of patients with hip fracture are associated with delirium. The study cohort included 406 patients with a mean age of 81 years (standard deviation 10 years), acutely admitted to hospital for surgical repair of a hip fracture. Delirium was assessed daily until the fifth postoperative day. CSF was collected from all 406 participants at the onset of spinal anaesthesia, and serum samples were drawn concurrently from 213 participants. Glucose and lactate in CSF were measured using amperometry, whereas plasma glucose was measured in the clinical laboratory using enzymatic photometry. Serum and CSF concentrations of the branched-chain amino acids, 3-hydroxyisobutyric acid, acetoacetate and β-hydroxybutyrate were measured using gas chromatography-tandem mass spectrometry (GC-MS/MS). In total, 224 (55%) patients developed delirium pre- or postoperatively. Ketone body concentrations (acetoacetate, β-hydroxybutyrate) and branched-chain amino acids were significantly elevated in the CSF but not in serum among patients with delirium, despite no group differences in glucose concentrations. The level of 3-hydroxyisobutyric acid was significantly elevated in both CSF and serum. An elevation of CSF lactate during delirium was explained by age and comorbidity. Our data suggest that altered glucose utilization and a shift to ketone body metabolism occurs in the brain during delirium.
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