ArticleBrain : a journal of neurology2024
Impaired glucose utilization in the brain of patients with delirium following hip fracture.
Article in Brain : a journal of neurology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 28 papers, 1 of them a synthesis that pooled it.
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The trial behind it
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Who cites it
28 citing papers in PubMed, 1 synthesis or guideline pooled it, 38 citations in OpenAlex.
- Predictive value of prognostic nutritional index for the long-term prognosis of elderly patients with fracture: a systematic review and meta-analysis.Frontiers in nutrition · 2025Pooled it
- Effect of preoperative warming combined with dexmedetomidine on postoperative delirium in elderly patients undergoing hip fracture surgery: a randomized controlled trial.Frontiers in medicine · 2026Trial
- Long-acting intranasal insulin for the treatment of delirium-a randomised clinical trial.Age and ageing · 2025Trial
- Trial
- Intranasal Insulin Diminishes Postoperative Delirium and Elevated Osteocalcin and Brain Derived Neurotrophic Factor in Older Patients Undergoing Joint Replacement: A Randomized, Double-Blind, Placebo-Controlled Trial.Drug design, development and therapy · 2025Trial
- Microglia in Perioperative Neurocognitive Disorders: Pathogenic Mechanisms and Emerging Concepts of Microglial Heterogeneity.Neurochemical research · 2026Review
- Development and Validation of a Perioperative Risk Update Model for Postoperative Delirium in Patients Aged ≥ 80 Years Undergoing Hip Fracture Surgery: A Retrospective Cohort Study.Clinics in orthopedic surgery · 2026Article
- Association between the preoperative stress hyperglycemia ratio and postoperative delirium in older adults undergoing non-cardiac surgery: a retrospective cohort study.European geriatric medicine · 2026Article
- CSF neurofilament light chain concentration in patients with delirium following hip fracture: a multicenter prospective study.BMC geriatrics · 2026Observational
- Article
- Ketone bodies mitigate against systemic inflammation-induced changes in brain energy metabolism and delirium-like deficits in aged mice.bioRxiv : the preprint server for biology · 2026Article
- Perioperative neurocognitive disorders as a neuroimmune landscape disorder: microglial priming, state heterogeneity, and time-dependent neuroinflammation.Frontiers in immunology · 2026Review
- Increased cerebrospinal fluid YKL-40 concentration in hip fracture patients with delirium.Brain communications · 2026Article
- Delirium Management in Critical Care: Are We Moving Forward or Still Treading Water?Medical sciences (Basel, Switzerland) · 2025Review
- Cerebral metabolic covariance in delirium: pattern response to symptomatic changes.Alzheimer's & dementia : the journal of the Alzheimer's Association · 2025Article
- Delirium is associated with incident dementia across the multimorbidity spectrum: a population-based cohort study.medRxiv : the preprint server for health sciences · 2025Article
- Potential therapeutic benefit of exogenous ketone ester administration in delirium: a narrative review.Critical care (London, England) · 2025Review
- Direct and indirect associations of stress hyperglycemia with delirium in older adults with community-acquired pneumonia: limited mediation by neutrophil-lymphocyte ratio and procalcitonin.BMC geriatrics · 2025Article
- Serum biomarkers of delirium in critical illness: a systematic review of mechanistic and diagnostic evidence.Intensive care medicine experimental · 2025Review
- Systemic Inflammation and Metabolic Changes After Cardiac Surgery and Postoperative Delirium Risk.Journal of clinical medicine · 2025Article
Corrections and comments
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Authors and funding
15 authors at 9 institutions in 3 countries.
Funding
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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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.