Plasma tryptophan and tyrosine levels are independent risk factors for delirium in critically ill patients

Intensive Care Medicine

Volumn 35, Issue 11, 2009, Pages 1886-1892

  Pandharipande, P P ^a,e   Morandi, A ^a,b,c   Adams, J R ^d   Girard, T D ^a,e   Thompson, J L ^a   Shintani, A K ^a   Ely, E Wesley ^a,e  

^a VANDERBILT UNIVERSITY MEDICAL CENTER   (United States)

^b Poliambulanza Hospital   (Italy)

^c GERIATRIC RESEARCH GROUP   (Italy)

^d VANDERBILT UNIVERSITY SCHOOL OF MEDICINE   (United States)

^e Education and Clinical Center (GRECC)   (United States)

Author keywords

Amino acids; Blood brain barrier; Delirium; Large neutral amino acids; LAT 1 transporter; Phenylalanine; Risk factor for delirium; Tryptophan; Tyrosine

Indexed keywords

AMINO ACID TRANSPORTER; PHENYLALANINE; TRYPTOPHAN; TYROSINE;

AGED; ANALYSIS OF VARIANCE; ARTICLE; BLOOD; CRITICAL ILLNESS; DELIRIUM; DISEASE COURSE; FEMALE; HOSPITALIZATION; HUMAN; MALE; MIDDLE AGED; PILOT STUDY; PREDICTION AND FORECASTING; PROBABILITY; REGRESSION ANALYSIS; RISK ASSESSMENT; RISK FACTOR; STATISTICAL MODEL; TIME; UNITED STATES;

AGED; AMINO ACID TRANSPORT SYSTEM L; ANALYSIS OF VARIANCE; CRITICAL ILLNESS; DELIRIUM; DISEASE PROGRESSION; FEMALE; HUMANS; LOGISTIC MODELS; MALE; MARKOV CHAINS; MIDDLE AGED; PHENYLALANINE; PILOT PROJECTS; PREDICTIVE VALUE OF TESTS; REGRESSION ANALYSIS; RISK ASSESSMENT; RISK FACTORS; SEVERITY OF ILLNESS INDEX; TENNESSEE; TIME FACTORS; TRYPTOPHAN; TYROSINE;

EID: 73949148084     PISSN: 03424642     EISSN: 14321238     Source Type: Journal    
DOI: 10.1007/s00134-009-1573-6     Document Type: Article

References (47)

1. Ely EW, Inouye SK, Bernard GR, Gordon S, Francis J, May L, Truman B, Speroff T, Gautam S, Margolin R, Hart RP, Dittus R (2001) Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). JAMA 286:2703-2710
2. Ely EW, Margolin R, Francis J, May L, Truman B, Dittus R, Speroff T, Gautam S, Bernard GR, Inouye SK (2001) Evaluation of delirium in critically ill patients: validation of the confusion assessment method for the intensive care unit (CAM-ICU). Crit Care Med 29:1370-1379
3. Bergeron N, Dubois MJ, Dumont M, Dial S, Skrobik Y (2001) Intensive care delirium screening checklist: evaluation of a new screening tool. Intensive Care Med 27:859-864
4. Thomason JW, Shintani A, Peterson JF, Pun BT, Jackson JC, Ely EW (2005) Intensive care unit delirium is an independent predictor of longer hospital stay: a prospective analysis of 261 non-ventilated patients. Crit Care 9:R375-R381
5. Ouimet S, Kavanagh BP, Gottfried SB, Skrobik Y (2007) Incidence, risk factors and consequences of ICU delirium. Intensive Care Med 33:66-73
6. Ely EW, Gautam S, Margolin R, Francis J, May L, Speroff T, Truman B, Dittus R, Bernard R, Inouye SK (2001) The impact of delirium in the intensive care unit on hospital length of stay. Intensive Care Med 27:1892-1900
7. Milbrandt EB, Deppen S, Harrison PL, Shintani AK, Speroff T, Stiles RA, Truman B, Bernard GR, Dittus RS, Ely EW (2004) Costs associated with delirium in mechanically ventilated patients. Crit Care Med 32:955-962
8. McNicoll L, Pisani MA, Zhang Y, Ely EW, Siegel MD, Inouye SK (2003) Delirium in the intensive care unit: occurrence and clinical course in older patients. J Am Geriatr Soc 51:591-598
9. Lin SM, Liu CY, Wang CH, Lin HC, Huang CD, Huang PY, Fang YF, Shieh MH, Kuo HP (2004) The impact of delirium on the survival of mechanically ventilated patients. Crit Care Med 32:2254-2259
10. Ely EW, Shintani A, Truman B, Speroff T, Gordon SM, Harrell FE Jr, Inouye SK, Bernard GR, Dittus RS (2004) Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA 291:1753-1762
11. Jackson JC, Gordon SM, Hart RP, Hopkins RO, Ely EW (2004) The association between delirium and cognitive decline: a review of the empirical literature. Neuropsychol Rev 14:87-98
12. Jackson JC, Gordon SM, Girard TD, Thomason JWW, Pun BT, Dunn J, Canonico AE, Light RW, Shintani AK, Thompson JL, Dittus RS, Bernard GR, Ely EW (2007) Delirium as a risk factor for long term cognitive impairment in mechanically ventilated ICU survivors. Am J Respir Crit Care Med 175:A22
13. Van Der Mast RC (1998) Pathophysiology of delirium. J Geriatr Psychiatry Neurol 11:138-145
14. Inouye SK, Ferrucci L (2006) Elucidating the pathophysiology of delirium and the interrelationship of delirium and dementia. J Gerontol A Biol Sci Med Sci 61:1277-1280
15. Gunther ML, Morandi A, Ely EW (2008) Pathophysiology of delirium in the intensive care unit. Crit Care Clin 24:45-65 viii
16. MacDonald A, Adamis D, Treloar A, Martin F (2007) C-reactive protein levels predict the incidence of delirium and recovery from it. Age Ageing 36:222-225
17. Kudoh A, Takase H, Katagai H, Takazawa T (2005) Postoperative interleukin-6 and cortisol concentrations in elderly patients with postoperative confusion. Neuroimmunomodulation 12:60-66
18. Pfister D, Siegemund M, ll-Kuster S, Smielewski P, Ruegg S, Strebel SP, Marsch SC, Pargger H, Steiner LA (2008) Cerebral perfusion in sepsis-associated delirium. Crit Care 12:R63
19. Fong TG, Bogardus ST, Daftary A, Auerbach E, Blumenfeld H, Modur S, Leo-Summers L, Seibyl J, Inouye SK (2007) Cerebral perfusion changes in older delirious patients using 99mTc HMPAO SPECT. J Gerontol Med Sci 61A:1294-1299
20. Van Der Mast RC, van den Broek WW, Fekkes D, Pepplinkhuizen L, Habbema JD (2000) Is delirium after cardiac surgery related to plasma amino acids and physical condition? J Neuropsychiatry Clin Neurosci 12:57-63
21. Van Der Mast RC, Fekkes D (2000) Serotonin and amino acids: partners in delirium pathophysiology? Semin Clin Neuropsychiatry 5:125-131
22. Flacker JM, Lipsitz LA (2000) Large neutral amino acid changes and delirium in febrile elderly medical patients. J Gerontol A Biol Sci Med Sci 55:B249-B252
23. Pardridge WM (1998) Blood-brain barrier carrier-mediated transport and brain metabolism of amino acids. Neurochem Res 23:635-644
24. Wurtman RJ, Hefti F, Melamed E (1980) Precursor control of neurotransmitter synthesis. Pharmacol Rev 32:315-335
25. Boado RJ, Li JY, Nagaya M, Zhang C, Pardridge WM (1999) Selective expression of the large neutral amino acid transporter at the blood-brain barrier. Proc Natl Acad Sci USA 96:12079-12084
26. Lewis MC, Barnett SR (2004) Postoperative delirium: the tryptophan dysregulation model. Med Hypotheses 63:402-406
27. Mizock BA, Sabelli HC, Dubin A, Javaid JI, Poulos A, Rackow EC (1990) Septic encephalopathy. Evidence for altered phenylalanine metabolism and comparison with hepatic encephalopathy. Arch Intern Med 150:443-449
28. Pandharipande PP, Pun BT, Herr DL, Maze M, Girard TD, Miller RR, Shintani AK, Thompson JL, Jackson JC, Deppen SA, Stiles RA, Dittus RS, Bernard GR, Ely EW (2007) Effect of sedation with dexmedetomidine vs lorazepam on acute brain dysfunction in mechanically ventilated patients: the MENDS randomized controlled trial. JAMA 298:2644-2653
29. Jorm AF, Scott R, Cullen JS, MacKinnon AJ (1991) Performance of the informant questionnaire on cognitive decline in the elderly (IQCODE) as a screening test for dementia. Psychol Med 21:785-790
30. Sessler CN, Gosnell MS, Grap MJ, Brophy GM, O'Neal PV, Keane KA, Tesoro EP, Elswick RK (2002) The Richmond agitation-sedation scale: validity and reliability in adult intensive care unit patients. Am J Respir Crit Care Med 166:1338-1344
31. Ely EW, Truman B, Shintani A, Thomason JW, Wheeler AP, Gordon S, Francis J, Speroff T, Gautam S, Margolin R, Sessler CN, Dittus RS, Bernard GR (2003) Monitoring sedation status over time in ICU patients: reliability and validity of the Richmond agitation-sedation scale (RASS). JAMA 289:2983-2991
32. Fekkes D, van DA, Edelman M, Voskuilen A (1995) Validation of the determination of amino acids in plasma by high-performance liquid chromatography using automated pre-column derivatization with o-phthaldialdehyde. J Chromatogr B Biomed Appl 669:177-186
33. Diggle PJ, Liang KY, Zeger SL (1994) Analysis of longitudinal data. Clarendon Press, Oxford
34. Zeger SL, Liang KY (1986) Longitudinal data analysis for discrete and continuous outcomes. Biometrics 42:121-130
35. Pandharipande P, Shintani A, Peterson J, Pun BT, Wilkinson GR, Dittus RS, Bernard GR, Ely EW (2006) Lorazepam is an independent risk factor for transitioning to delirium in intensive care unit patients. Anesthesiology 104:21-26
36. Pandharipande P, Cotton BA, Shintani A, Thompson J, Pun BT, Morris JA Jr, Dittus R, Ely EW (2008) Prevalence and risk factors for development of delirium in surgical and trauma intensive care unit patients. J Trauma 65:34-41
37. Boyer EW, Shannon M (2005) The serotonin syndrome. N Engl J Med 352:1112-1120
38. Heyes MP, Saito K, Crowley JS, Davis LE, Demitrack MA, Der M, Dilling LA, Elia J, Kruesi MJ, Lackner A (1992) Quinolinic acid and kynurenine pathway metabolism in inflammatory and non-inflammatory neurological disease. Brain 115(Pt 5):1249-1273
39. Christen S, Peterhans E, Stocker R (1990) Antioxidant activities of some tryptophan metabolites: possible implication for inflammatory diseases. Proc Natl Acad Sci USA 87:2506-2510
40. Muller N, Schwarz MJ (2007) The immune-mediated alteration of serotonin and glutamate: towards an integrated view of depression. Mol Psychiatry 12:988-1000
41. Miuller N, Schwarz MJ (2007) The immunological basis of glutamatergic disturbance in schizophrenia: towards an integrated view. J Neural Transm Suppl 26:9-280
42. Wolf H (1974) The effect of hormones and vitamin B6 on urinary excretion of metabolites of the kynurenine pathway. Scand J Clin Lab Invest 136:1-186
43. Uchida K, Aoki T, Ishizuka B (1999) Postoperative delirium and plasma melatonin. Med Hypotheses 53:103-106
44. Balan S, Leibovitz A, Zila SO, Ruth M, Chana W, Yassica B, Rahel B, Richard G, Neumann E, Blagman B, Habot B (2003) The relation between the clinical subtypes of delirium and the urinary level of 6-SMT. J Neuropsychiatry Clin Neurosci 15:363-366
45. Pandharipande P, Cotton BA, Shintani A, Thompson J, Costabile S, Truman PB, Dittus R, Ely EW (2007) Motoric subtypes of delirium in mechanically ventilated surgical and trauma intensive care unit patients. Intensive Care Med 33:1726-1731
46. Marquis F, Ouimet S, Riker R, Cossette M, Skrobik Y (2007) Individual delirium symptoms: do they matter? Crit Care Med 35:2533-2537
47. Van Der Mast RC, van den Broek WW, Fekkes D, Pepplinkhuizen L, Habbema JD (1999) Incidence of and preoperative predictors for delirium after cardiac surgery. J Psychosom Res 46:479-483