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09.03.2018 | Original

Relationships between markers of neurologic and endothelial injury during critical illness and long-term cognitive impairment and disability

verfasst von: Christopher G. Hughes, Mayur B. Patel, Nathan E. Brummel, Jennifer L. Thompson, J. Brennan McNeil, Pratik P. Pandharipande, James C. Jackson, Rameela Chandrasekhar, Lorraine B. Ware, E. Wesley Ely, Timothy D. Girard

Erschienen in: Intensive Care Medicine | Ausgabe 3/2018

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Abstract

Purpose

Neurologic and endothelial injury biomarkers are associated with prolonged delirium during critical illness and may reflect injury pathways that lead to poor long-term outcomes. We hypothesized that blood–brain barrier (BBB), neuronal, and endothelial injury biomarkers measured during critical illness are associated with cognitive impairment and disability after discharge.

Methods

We enrolled adults with respiratory failure and/or shock and measured plasma concentrations of BBB (S100B), neuronal (UCHL1, BDNF), and endothelial (E-selectin, PAI-1) injury markers within 72 h of ICU admission. At 3 and 12 months post-discharge, we assessed participants’ global cognition, executive function, and activities of daily living (ADL). We used multivariable regression to determine whether biomarkers were associated with outcomes after adjusting for relevant demographic and acute illness covariates.

Results

Our study included 419 survivors of critical illness with median age 59 years and APACHE II score 25. Higher S100B was associated with worse global cognition at 3 and 12 months (P = 0.008; P = 0.01). UCHL1 was nonlinearly associated with global cognition at 3 months (P = 0.02). Higher E-selectin was associated with worse global cognition (P = 0.006 at 3 months; P = 0.06 at 12 months). BDNF and PAI-1 were not associated with global cognition. No biomarkers were associated with executive function. Higher S100B (P = 0.05) and E-selectin (P = 0.02) were associated with increased disability in ADLs at 3 months.

Conclusions

S100B, a marker of BBB and/or astrocyte injury, and E-selectin, an adhesion molecule and marker of endothelial injury, are associated with long-term cognitive impairment after critical illness, findings that may reflect mechanisms of critical illness brain injury.

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Titel: Relationships between markers of neurologic and endothelial injury during critical illness and long-term cognitive impairment and disability
verfasst von: Christopher G. Hughes
Mayur B. Patel
Nathan E. Brummel
Jennifer L. Thompson
J. Brennan McNeil
Pratik P. Pandharipande
James C. Jackson
Rameela Chandrasekhar
Lorraine B. Ware
E. Wesley Ely
Timothy D. Girard
Publikationsdatum: 09.03.2018
Verlag: Springer Berlin Heidelberg
Erschienen in: Intensive Care Medicine / Ausgabe 3/2018
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-018-5120-1

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Relationships between markers of neurologic and endothelial injury during critical illness and long-term cognitive impairment and disability

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