Potential Influence of Aspirin on Neopterin and Tryptophan Levels in Patients with a Delirium.

Angelique Egberts,Durk Fekkes,Gijsbertus Ziere,Tischa Van Der Cammen,Francesco Mattace-Raso

doi:10.3390/geriatrics1020010

Abstract

In an in vitro study, it was found that aspirin might decrease neopterin production and tryptophan degradation. The aim of the present study was to evaluate the possible association between aspirin use and mean neopterin and tryptophan levels in patients with and without a delirium and whether the use of aspirin is associated with a decreased prevalence of delirium. Neopterin and tryptophan levels were determined previously in acutely ill admitted patients aged ≥65 years. The possible influence of aspirin on mean levels of neopterin and tryptophan was investigated with univariate analysis of variance in adjusted models. Eighty-three patients were included; 22 had a delirium. In patients without a delirium (no aspirin (n = 31) versus aspirin (n = 27)), mean neopterin levels were 47.0 nmol/L versus 43.6 nmol/L (p = 0.645) and tryptophan levels were 33.1 µmol/L versus 33.9 µmol/L (p = 0.816). In patients with a delirium (no aspirin (n = 13) versus aspirin (n = 9)), mean neopterin levels were 77.8 nmol/L versus 71.1 nmol/L (p = 0.779) and tryptophan levels were 22.4 µmol/L versus 27.3 µmol/L (p = 0.439). No difference was found in the distribution of aspirin users between patients with and without a delirium. In this study, we found that the use of aspirin had no significant effect on mean levels of neopterin and tryptophan. However, the raw data suggest that there might be a potential influence in patients with a delirium. Aspirin use was not associated with a decreased prevalence of delirium.

Highlights

Delirium, an acute neuropsychiatric syndrome, is a common, severe complication in the elderly and is associated with poor clinical outcomes including increased morbidity and mortality, prolonged hospital stay, loss of independence, and increased rates of cognitive decline [1,2]
Of the 86 patients enrolled in the Delirium In The Old (DITO) study, 80 were included in the stratified analyses to examine the effect of aspirin use on neopterin and tryptophan levels
Three patients were excluded due to unclear data regarding the use of non-steroidal anti-inflammatory drugs (NSAIDs) in the days preceding hospital admission, 1 patient used diclofenac and 2 patients used carbasalate calcium concomitantly with another NSAID

Summary

Introduction

An acute neuropsychiatric syndrome, is a common, severe complication in the elderly and is associated with poor clinical outcomes including increased morbidity and mortality, prolonged hospital stay, loss of independence, and increased rates of cognitive decline [1,2]. It might be required to interrupt in multiple biochemical pathways at the same time to prevent, treat, or to lower the severity of a delirium. Activation of the immune system, oxidative stress, and disturbances in the serotonergic neurotransmission may all contribute to the development of a delirium. We found that acutely ill hospitalized elderly patients with a delirium have increased levels of neopterin [3]. Neopterin is produced primarily by activated monocytes and macrophages in response to the pro-inflammatory cytokine interferon-gamma (IFN-γ) and its levels reflect the amount of cell-mediated immune activation

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