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Title: Association between Serum IGF-I levels and Postoperative Delirium in Elderly Subjects Undergoing Elective Knee Arthroplasty
Authors: Yen, T.E
Allen, J.C 
Rivelli, S.K
Patterson, S.C
Metcalf, M.R
Flink, B.J
Mirrakhimov, A.E
Lagoo, S.A
Vail, T.P
Young, C.C
Moon, R.E
Trzepacz, P.T
Kwatra, M.M
Keywords: IGF1 protein, human
somatomedin C
elective surgery
knee replacement
prospective study
risk factor
statistical model
very elderly
Aged, 80 and over
Arthroplasty, Replacement, Knee
Elective Surgical Procedures
Insulin-Like Growth Factor I
Logistic Models
Prospective Studies
Risk Factors
Issue Date: 2016
Publisher: Nature Publishing Group
Citation: Yen, T.E, Allen, J.C, Rivelli, S.K, Patterson, S.C, Metcalf, M.R, Flink, B.J, Mirrakhimov, A.E, Lagoo, S.A, Vail, T.P, Young, C.C, Moon, R.E, Trzepacz, P.T, Kwatra, M.M (2016). Association between Serum IGF-I levels and Postoperative Delirium in Elderly Subjects Undergoing Elective Knee Arthroplasty. Scientific Reports 6 : 20736. ScholarBank@NUS Repository.
Abstract: Evidence is mixed for an association between serum insulin-like growth factor-I (IGF-I) levels and postoperative delirium (POD). The current study assessed preoperative serum IGF-I levels as a predictor of incident delirium in non-demented elderly elective knee arthroplasty patients. Preoperative serum levels of total IGF-I were measured using a commercially available Human IGF-I ELISA kit. POD incidence and severity were determined using DSM-IV criteria and the Delirium Rating Scale-Revised-98 (DRS-R98), respectively. Median IGF-I levels in delirious (62.6 ng/ml) and non-delirious groups (65.9 ng/ml) were not significantly different (p = 0.141). The ratio (95% CI) of geometric means, D/ND, was 0.86 (0.70, 1.06). The Hodges-Lehmann median difference estimate was 7.23 ng/mL with 95% confidence interval (â '2.32, 19.9). In multivariate logistic regression analysis IGF-I level was not a significant predictor of incident POD after correcting for medical comorbidities. IGF-I levels did not correlate with DRS-R98 scores for delirium severity. In conclusion, we report no evidence of association between serum IGF-I levels and incidence of POD, although the sample size was inadequate for a conclusive study. Further efforts to investigate IGF-I as a delirium risk factor in elderly should address comorbidities and confounders that influence IGF-I levels.
Source Title: Scientific Reports
ISSN: 20452322
DOI: 10.1038/srep20736
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