• Michael E Reznik, Roshini Kalagara, Scott Moody, Jonathan Drake, Seth A Margolis, Sevdenur Cizginer, Ali Mahta, Shyam S Rao, Christoph Stretz, Linda C Wendell, Bradford B Thompson, Wael F Asaad, Karen L Furie, Richard N Jones, and Lori A Daiello.
• Department of Neurology, Brown University, Alpert Medical School, Providence, RI, USA; Department of Neurosurgery, Brown University, Alpert Medical School, Providence, RI, USA. Electronic address: Michael_Reznik@brown.edu.
• J Crit Care. 2021 Aug 1; 64: 62-67.

PurposeTo examine associations between physiologic stress and delirium in the setting of a direct neurologic injury.Materials And MethodsWe obtained initial neutrophil-to-lymphocyte ratio (NLR), glucose, and troponin in consecutive non-comatose patients with non-traumatic intracerebral hemorrhage (ICH) over 1 year, then used multivariable regression models to determine associations between each biomarker and incident delirium. Delirium diagnoses were established using DSM-5-based methods, with exploratory analyses further categorizing delirium as first occurring <24 h ("early-onset") or > 24 h after presentation ("later-onset").ResultsOf 284 patients, delirium occurred in 55% (early-onset: 39% [n = 111]; later-onset: 16% [n = 46]). Patients with delirium had higher NLR (mean 9.0 ± 10.4 vs. 6.4 ± 5.5; p = 0.01), glucose (mean 146.5 ± 59.6 vs. 129.9 ± 41.4 mg/dL; p = 0.008), and a higher frequency of elevated troponin (>0.05 ng/mL; 21% vs. 10%, p = 0.02). In adjusted models, elevated NLR (highest quartile: OR 3.4 [95% CI 1.5-7.8]), glucose (>180 mg/dL: OR 3.1 [95% CI 1.1-8.2]), and troponin (OR 3.0 [95% CI 1.2-7.2]) were each associated with delirium, but only initial NLR was specifically associated with later-onset delirium and with delirium in non-mechanically ventilated patients.ConclusionsStress-related biomarkers corresponding to multiple organ systems are associated with ICH-related delirium. Early NLR elevation may also predict delayed-onset delirium, potentially implicating systemic inflammation as a contributory delirium mechanism.Copyright © 2021 Elsevier Inc. All rights reserved.

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