Lack of association of S100β and neuron-specific enolase with mortality in critically ill patients

Objective: To evaluate the relationship between brain damage biomarkers and mortality in the intensive care unit (ICU). Methods: The sample comprised 70 patients admitted to an ICU. Blood samples were collected from all patients on ICU admission, and levels of S100β and neuron-specific enolase (NSE) were determined by ELISA. Results: Acute Physiologic and Chronic Health Evaluation (APACHE II) score was associated with mortality, but NSE and S100β were not associated with this outcome. In contrast, S100β levels were significantly higher in delirious and non-delirious patients who required mechanical ventilation during ICU stay. Conclusion: Levels of brain biomarkers at the time of ICU admission did not predict mortality in critically ill patients

CAM-ICU and ICDSC agreement in medical and surgical ICU patients is influenced by disease severity.

IntroductionDelirium is a prevalent condition in patients admitted to intensive care units (ICU) associated with worse outcomes. The principal aim of the present study was compare the agreement between two tools for delirium assessment in medical and surgical patients admitted to the ICU.MethodsConsecutive adult surgical and medical patients admitted to the ICU for more than 24 hours between March 2009 and September 2010 were included. Delirium was evaluated twice a day using the Intensive Care Delirium Screening Checklist (ICDSC) and Confusion Assessment Method adapted to the Intensive Care Unit (CAM-ICU). The kappa (k) and AC1 coefficients were calculated as a measure of agreement between the CAM-ICU and ICDSC.ResultsA total of 595 patients were enrolled in the study. There were 69 (12%) emergency surgical, 207 (35%) elective surgical and 319 (54%) medical patients. Delirium incidence evaluated by the ICDSC, but not by the CAM-ICU, was similar among the three groups. Overall agreement between CAM-ICU and ICDSC was moderate (k = 0.5) to substantial (AC1 = 0.71). In medical patients the agreement between the two instruments was moderate (k = 0.53) to substantial (AC1 = 0.76). The agreement between the two tools in emergency surgical patients was also moderate (k = 0.53) to substantial (AC1 = 0.68). In elective surgical patients the agreement between the two instruments was low (k = 0.42) to substantial (AC1 = 0.74).Agreement rates seemed to be influenced by disease severity. The agreement rate in the general ICU population with APACHE II = ConclusionsThe agreement rates between CAM-ICU and ICDSC may vary between different groups of ICU patients and seems to be affected by disease severity

Flowchart of patients in study.

<p>ICU = Intensive Care Unit.</p

Comparison of CAM-ICU and ICDSC for delirium diagnosis according to the need for mechanical ventilation.

<p>Comparison of CAM-ICU and ICDSC for delirium diagnosis according to the need for mechanical ventilation.</p

Main patients’ characteristics and type of admission.

<p>Data are quoted as mean ± SD or number (%).</p><p>SD = Standard deviation.</p><p>D1 = First day of ICU admission.</p><p>D3 = Third day of ICU admission.</p>*<p><i>P</i><0.05 from emergency surgery and medical groups.</p>#<p><i>P</i><0.05 from emergency and elective surgery.</p