Trial reportJournal of neuroinflammation2016
Cerebrospinal fluid levels of neopterin are elevated in delirium after hip fracture.
Trial report in Journal of neuroinflammation, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers, 4 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
21 citing papers in PubMed, 4 syntheses or guidelines pooled it, 43 citations in OpenAlex.
- A Systematic Review and Meta-Analysis of the Role of Peripheral Inflammation in Delirium.Brain and behavior · 2025Pooled it
- Predisposing and Precipitating Factors Associated With Delirium: A Systematic Review.JAMA network open · 2023Pooled it
- Increased risk of dementia among people with a history of fractures: a systematic review and meta-analysis of population-based studies.Frontiers in neurology · 2023Pooled it
- Pre-operative biomarkers and imaging tests as predictors of post-operative delirium in non-cardiac surgical patients: a systematic review.BMC anesthesiology · 2019Pooled it
- Mind Gaps and Bone Snaps: Exploring the Connection Between Alzheimer's Disease and Osteoporosis.Current osteoporosis reports · 2024Review
- CSF Neopterin Levels Are Elevated in Various Neurological Diseases and Aging.Journal of clinical medicine · 2024Article
- Effects of dexmedetomidine-ropivacaine assisted combined spinal-epidural anesthesia on neutrophil-lymphocyte ratio and postoperative delirium in elderly patients with intertrochanteric femoral fracture.Frontiers in pharmacology · 2024Article
- Preoperative Risk Factors Associated with Increased Incidence of Postoperative Delirium: Systematic Review of Qualified Clinical Studies.Geriatrics (Basel, Switzerland) · 2023Review
- Study protocol: understanding the pathophysiologic mechanisms underlying delirium in older people undergoing hip fracture surgery.BMC geriatrics · 2021Article
- Neutrophil-lymphocyte ratio as a predictor of delirium in older internal medicine patients: a prospective cohort study.BMC geriatrics · 2021Article
- Cerebrospinal fluid metabolomics: detection of neuroinflammation in human central nervous system disease.Clinical & translational immunology · 2021Review
- Cerebrospinal fluid catecholamines in delirium and dementia.Brain communications · 2021Article
- Association between increased neutrophil-to-lymphocyte ratio and postoperative delirium in elderly patients with total hip arthroplasty for hip fracture.BMC psychiatry · 2020Article
- Article
- Evaluating Mechanisms of Postoperative Delirium and Cognitive Dysfunction Following Elective Spine Surgery in Elderly Patients (CONFESS): Protocol for a Prospective Observational Trial.JMIR research protocols · 2020Article
- Pterins as Diagnostic Markers of Mechanical and Impact-Induced Trauma: A Systematic Review.Journal of clinical medicine · 2019Review
- Could Neutrophil-to-Lymphocyte Ratio (NLR) Serve as a Potential Marker for Delirium Prediction in Patients with Acute Ischemic Stroke? A Prospective Observational Study.Journal of clinical medicine · 2019Article
- Differences in potential biomarkers of delirium between acutely ill medical and elective cardiac surgery patients.Clinical interventions in aging · 2019Article
- CSF sTREM2 in delirium-relation to Alzheimer's disease CSF biomarkers Aβ42, t-tau and p-tau.Journal of neuroinflammation · 2018Article
- Temporal biomarker profiles and their association with ICU acquired delirium: a cohort study.Critical care (London, England) · 2018Article
Corrections and comments
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Authors and funding
9 authors at 3 institutions in 3 countries.
Funding
Abstract
backgroundThe inflammatory cell product neopterin is elevated in serum before and during delirium. This suggests a role for disordered cell-mediated immunity or oxidative stress. Cerebrospinal fluid (CSF) neopterin levels reflect brain neopterin levels more closely than serum levels. Here we hypothesized that CSF neopterin levels would be higher in delirium.
methodsIn this prospective cohort study, 139 elderly patients with acute hip fracture were recruited in Oslo and Edinburgh. Delirium was diagnosed with the confusion assessment method performed daily pre-operatively and on the first 5 days post-operatively. Paired CSF and blood samples were collected at the onset of spinal anaesthesia. Neopterin levels were measured using high-performance liquid chromatography.
resultsSixty-four (46 %) of 139 hip fracture patients developed delirium perioperatively. CSF neopterin levels were higher in delirium compared to controls (median 29.6 vs 24.7 nmol/mL, p = 0.003), with highest levels in patients who developed delirium post-operatively. Serum neopterin levels were also higher in delirium (median 37.0 vs 27.1 nmol/mL, p = 0.003). CSF neopterin remained significantly associated with delirium after controlling for relevant risk factors. Higher neopterin levels were associated with poorer outcomes (death or new institutionalization) 1 year after surgery (p = 0.02 for CSF and p = 0.03 for serum).
conclusionsThis study is the first to examine neopterin in CSF from patients with delirium. Our findings suggest potential roles for activation of cell-mediated immune responses or oxidative stress in the delirium process. High levels of serum or CSF neopterin in hip fracture patients may also be useful in predicting poor outcomes.
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Registered trials
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