Association between Serum IGF-I levels and Postoperative Delirium in Elderly Subjects Undergoing Elective Knee Arthroplasty

Timothy E Yen, John C Allen, Sarah K Rivelli, Stephanie C Patterson, Meredith R Metcalf, Benjamin J Flink, Aibek E Mirrakhimov, Sandhya A Lagoo, Thomas P Vail, Christopher C Young, Richard E Moon, Paula T Trzepacz, Madan M Kwatra, Timothy E Yen, John C Allen, Sarah K Rivelli, Stephanie C Patterson, Meredith R Metcalf, Benjamin J Flink, Aibek E Mirrakhimov, Sandhya A Lagoo, Thomas P Vail, Christopher C Young, Richard E Moon, Paula T Trzepacz, Madan M Kwatra

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 (-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.

Conflict of interest statement

Dr. Trzepacz was a full-time salaried employee and minor shareholder of Eli Lilly and Company during the conduct of this study, and copyright owner of the Delirium Rating Scale-Revised-98 but does not charge a fee for not-for-profit use of this scale.

Figures

Figure 1. Distributions of preoperative IGF-I serum…
Figure 1. Distributions of preoperative IGF-I serum levels by percentage for delirious and non-delirious groups.
The distributions of IGF-I concentrations for the Delirious and Non-delirious groups exhibited considerable overlap, and there was no difference in median IGF-I levels between groups.

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