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A Novel Way to Ward Off Delirium


February 16, 2014

There is no sure-fire treatment currently available for delirium. However, statins apparently reduce delirium risk in the critically ill, providing a possible therapy for the most common neuropsychiatric disorder affecting hospitalized patients.

For a new observational study, investigators monitored 470 consecutive critical care patients admitted to the intensive care unit of an English general hospital from August 2011 to February 2012. Patients — 151 of them — were given statins only if they were on the therapy before admission. According to the study, 167 patients had delirium once for a medium duration of 2 days, and 44 had it throughout their hospitalization.

For every day statin users continued to receive the drug in the ICU, the odds of being delirium-free increased by 39%, according to the study. So although pre-admission statins did not impact delirium, the administration of statins during hospitalization did reduce the risk on a day-to-day basis, which, according to the researchers, showed statins actively protect against the condition.

The critically ill, elderly trauma patients, and patients with dementia are particularly susceptible, said study lead author Dr. Valerie Page, of the Watford General Hospital in the United Kingdom.

“Delirium is predictive of worse outcomes, including death and long-term cognitive impairment equivalent to a moderate traumatic brain injury or mild dementia, regardless of age,” she added. “The longer the duration of delirium, the worse the cognitive outcome.”

The study noted delirium is a form of acute brain dysfunction associated with increased mortality at 6 months and risk of cognitive impairment at 12 months, which reduces quality of life and increases healthcare costs.

Although the physiological causes of delirium are largely unknown, the study’s authors pointed to neuroinflammation driving oxidative damage and apoptosis, which could induce cognitive impairment. They further noted that higher levels of procalcitonin and C-reactive protein eliminate or lessen the onset of delirium, regardless of whether patients have sepsis, which indicates systemic inflammation plays a role in the disorder’s development.

Statins, in addition to inhibiting cholesterol synthesis, show anti-inflammatory properties that may take effect within 24 hours of administration, said the researchers, which might account for the reduction in delirium risk.

“The findings suggest that statin therapy may modify delirium in critically ill patients, and if a patient is on statins before admission, they should be continued on statins, which is currently not always the case,” said Dr. Page.

The study was published online in the American Journal of Respiratory and Critical Care Medicine.

 

—Dan Cook

 

Reference:

1. Page VJ, Davis D, Zhao XB, et al. Statin use and risk of delirium in the critically ill. Am J Respir Crit Care Med. 2014 Jan 13. [Epub ahead of print]

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