Study protocol: understanding the pathophysiologic mechanisms underlying delirium in older people undergoing hip fracture surgery

Study protocol: understanding the pathophysiologic mechanisms underlying delirium in older people undergoing hip fracture surgery

Abstract Background Postoperative delirium (POD) is a common complication of older people undergoing hip fracture surgery, which negatively affects clinical- and healthcare-related outcomes. Unfortunately, POD pathophysiology is still largely unknown, despite previous studies showing that neuroinfla...

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Autores principales: R. Gamberale, C. D’Orlando, S. Brunelli, R. Meneveri, P. Mazzola, G. Foti, G. Bellani, G. Zatti, D. Munegato, S. Volpato, A. Zurlo, G. Caruso, A. Andreano, M. G. Valsecchi, G. Bellelli
Formato: article
Lenguaje:EN
Publicado: BMC 2021
Materias:
Postoperative delirium
Neuroinflammation
Sarcopenia
Biomarkers
Geriatrics
RC952-954.6
Acceso en línea:https://doaj.org/article/0f1681a37a1e4360b8e883507fd0d1ff
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spelling oai:doaj.org-article:0f1681a37a1e4360b8e883507fd0d1ff2021-11-07T12:16:36ZStudy protocol: understanding the pathophysiologic mechanisms underlying delirium in older people undergoing hip fracture surgery10.1186/s12877-021-02584-11471-2318https://doaj.org/article/0f1681a37a1e4360b8e883507fd0d1ff2021-11-01T00:00:00Zhttps://doi.org/10.1186/s12877-021-02584-1https://doaj.org/toc/1471-2318Abstract Background Postoperative delirium (POD) is a common complication of older people undergoing hip fracture surgery, which negatively affects clinical- and healthcare-related outcomes. Unfortunately, POD pathophysiology is still largely unknown, despite previous studies showing that neuroinflammation, neuroendocrine dysfunction, increased reactive oxidative stress (ROS), and endothelial dysfunctions may be involved. There is also evidence that many of the pathophysiological mechanisms which are involved in delirium are involved in sarcopenia too. This article describes the protocol of a pilot study to evaluate the feasibility of a larger one that will explore the pathophysiological mechanisms correlating POD with sarcopenia. We will analyse whether various biomarkers reflecting neuroinflammation, ROS, neuroendocrine disorders, and microvasculature lesions will be simultaneously expressed in in the blood, cerebrospinal fluid (CSF), and muscles of patients developing POD. Methods Two centres will be involved in this study, each recruiting a convenient sample of ten older patients with hip fracture. All of them will undergo a baseline Comprehensive Geriatric Assessment, which will be used to construct a Rockwood-based Frailty Index (FI). Blood samples will be collected for each patient on the day of surgery and 1 day before. Additionally, CSF and muscle fragments will be taken and given to a biologist for subsequent analyses. The presence of POD will be assessed in each patient every morning until hospital discharge using the 4AT. Delirium subtypes and severity will be assessed using the Delirium Motor Subtype Scale-4 and the Delirium-O-Meter, respectively. We will also evaluate the patient’s functional status at discharge, using the Cumulated Ambulation Score. Discussion This study will be the first to correlate biomarkers of blood, CSF, and muscle in older patients with hip fracture.R. GamberaleC. D’OrlandoS. BrunelliR. MeneveriP. MazzolaG. FotiG. BellaniG. ZattiD. MunegatoS. VolpatoA. ZurloG. CarusoA. AndreanoM. G. ValsecchiG. BellelliBMCarticlePostoperative deliriumNeuroinflammationSarcopeniaBiomarkersGeriatricsRC952-954.6ENBMC Geriatrics, Vol 21, Iss 1, Pp 1-9 (2021)
institution DOAJ
collection DOAJ
language EN
topic Postoperative delirium
Neuroinflammation
Sarcopenia
Biomarkers
Geriatrics
RC952-954.6
spellingShingle Postoperative delirium
Neuroinflammation
Sarcopenia
Biomarkers
Geriatrics
RC952-954.6
R. Gamberale
C. D’Orlando
S. Brunelli
R. Meneveri
P. Mazzola
G. Foti
G. Bellani
G. Zatti
D. Munegato
S. Volpato
A. Zurlo
G. Caruso
A. Andreano
M. G. Valsecchi
G. Bellelli
Study protocol: understanding the pathophysiologic mechanisms underlying delirium in older people undergoing hip fracture surgery
description Abstract Background Postoperative delirium (POD) is a common complication of older people undergoing hip fracture surgery, which negatively affects clinical- and healthcare-related outcomes. Unfortunately, POD pathophysiology is still largely unknown, despite previous studies showing that neuroinflammation, neuroendocrine dysfunction, increased reactive oxidative stress (ROS), and endothelial dysfunctions may be involved. There is also evidence that many of the pathophysiological mechanisms which are involved in delirium are involved in sarcopenia too. This article describes the protocol of a pilot study to evaluate the feasibility of a larger one that will explore the pathophysiological mechanisms correlating POD with sarcopenia. We will analyse whether various biomarkers reflecting neuroinflammation, ROS, neuroendocrine disorders, and microvasculature lesions will be simultaneously expressed in in the blood, cerebrospinal fluid (CSF), and muscles of patients developing POD. Methods Two centres will be involved in this study, each recruiting a convenient sample of ten older patients with hip fracture. All of them will undergo a baseline Comprehensive Geriatric Assessment, which will be used to construct a Rockwood-based Frailty Index (FI). Blood samples will be collected for each patient on the day of surgery and 1 day before. Additionally, CSF and muscle fragments will be taken and given to a biologist for subsequent analyses. The presence of POD will be assessed in each patient every morning until hospital discharge using the 4AT. Delirium subtypes and severity will be assessed using the Delirium Motor Subtype Scale-4 and the Delirium-O-Meter, respectively. We will also evaluate the patient’s functional status at discharge, using the Cumulated Ambulation Score. Discussion This study will be the first to correlate biomarkers of blood, CSF, and muscle in older patients with hip fracture.
format article
author R. Gamberale
C. D’Orlando
S. Brunelli
R. Meneveri
P. Mazzola
G. Foti
G. Bellani
G. Zatti
D. Munegato
S. Volpato
A. Zurlo
G. Caruso
A. Andreano
M. G. Valsecchi
G. Bellelli
author_facet R. Gamberale
C. D’Orlando
S. Brunelli
R. Meneveri
P. Mazzola
G. Foti
G. Bellani
G. Zatti
D. Munegato
S. Volpato
A. Zurlo
G. Caruso
A. Andreano
M. G. Valsecchi
G. Bellelli
author_sort R. Gamberale
title Study protocol: understanding the pathophysiologic mechanisms underlying delirium in older people undergoing hip fracture surgery
title_short Study protocol: understanding the pathophysiologic mechanisms underlying delirium in older people undergoing hip fracture surgery
title_full Study protocol: understanding the pathophysiologic mechanisms underlying delirium in older people undergoing hip fracture surgery
title_fullStr Study protocol: understanding the pathophysiologic mechanisms underlying delirium in older people undergoing hip fracture surgery
title_full_unstemmed Study protocol: understanding the pathophysiologic mechanisms underlying delirium in older people undergoing hip fracture surgery
title_sort study protocol: understanding the pathophysiologic mechanisms underlying delirium in older people undergoing hip fracture surgery
publisher BMC
publishDate 2021
url https://doaj.org/article/0f1681a37a1e4360b8e883507fd0d1ff
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