Abstract
In elderly population sepsis is one of the leading causes of intensive care unit (ICU) admissions in the United States. Sepsis-induced delirium (SID) is the most frequent cause of delirium in ICU (Martin et al., 2010). Together delirium and SID represent under-recognized public health problems which place an increasing financial burden on the US health care system, currently estimated at 143–152 billion dollars per year (Leslie et al., 2008). The interest in SID was recently reignited as it was demonstrated that, contrary to prior beliefs, cognitive deficits induced by this condition may be irreversible and lead to dementia (Pandharipande et al., 2013; Brummel et al., 2014). Conversely, it is construed that diagnosing SID early or mitigating its full blown manifestations may preempt geriatric cognitive disorders. Biological markers specific for sepsis and SID would facilitate the development of potential therapies, monitor the disease process and at the same time enable elderly individuals to make better informed decisions regarding surgeries which may pose the risk of complications, including sepsis and delirium. This article proposes a battery of peripheral blood markers to be used for diagnostic and prognostic purposes in sepsis and SID. Though each individual marker may not be specific enough, we believe that together as a battery they may achieve the necessary accuracy to answer two important questions: who may be vulnerable to the development of sepsis, and who may develop SID and irreversible cognitive deficits following sepsis?
Highlights
At present there are no biological markers to indicate vulnerability to sepsis or to the CNS dysfunction following it
Recent studies have shown that delirium in general and Sepsis-induced delirium (SID) in particular are unrecognized by clinicians in 32– 66% of cases and because of their resemblance to psychiatric conditions, patients with delirium are frequently admitted to psychiatric wards, delaying much needed interventions (Leslie et al, 2008; Reeves et al, 2010)
This miR seems to block the transcription of CHRNA 7 gene which codes for alpha 7 nicotinic cholinergic receptors, while at the same time augments the expression of RNF128, the Gene Related to Anergia in Lymphocytes (GRAIL), a gene involved in sepsis associated immune suppression (SAIS)
Summary
At present there are no biological markers to indicate vulnerability to sepsis or to the CNS dysfunction following it. Electroencephalography (EEG) and various instruments such as Confusion Assessment Method (CAM), Delirium Rating Scale (DRS) or Delirium Symptoms Interview (DSI) are currently used for diagnosing delirium, they are not specific for SID and difficult to perform in sedated or intubated ICU patients (Zampieri et al, 2011). Recent studies have shown that delirium in general and SID in particular are unrecognized by clinicians in 32– 66% of cases and because of their resemblance to psychiatric conditions, patients with delirium are frequently admitted to psychiatric wards, delaying much needed interventions (Leslie et al, 2008; Reeves et al, 2010). In order to avoid this problem the Society for Academic Emergency Medicine Geriatrics Task Force designated delirium screening a key quality indicator in elderly care (Terrell et al, 2009)
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