C‐reactive protein, delirium, and other psychological symptoms among patients with advanced cancer

Abstract

BackgroundIt remains unclear whether a relationship exists between elevated C‐reactive protein (CRP) levels and delirium. The primary aim was to investigate the relationship between CRP and delirium in advanced cancer.MethodsThis study was a multicenter prospective cohort study conducted in palliative care units. At baseline, the physicians diagnosed delirium. On the seventh day, they evaluated whether new delirium had occurred. Subjects were divided into four groups according to CRP levels. We assessed the associations between CRP levels and proportions of delirium. To evaluate the relationship between CRP and delirium, adjusted odd ratios (ORs) and 95% confidence intervals (CIs) were calculated in the logistic models.ResultsAmong 1896 patients, 1354 patients were eligible for analyses. We classified them into four groups: low (CRP < 1 mg/dl) (n = 170), moderate (1 ≤ CRP < 5 mg/dl) (n = 453), high (5 ≤ CRP < 10 mg/dl) (n = 334), and very high (10 mg/dl ≤ CRP) (n = 397). The incidence of delirium significantly increased with increasing CRP levels (P = 0.02). In model 1, significantly higher adjusted ORs than in the low CRP group were observed in the high CRP and very high CRP groups (1.63 [95% CI 1.06–2.50], P = 0.03; 1.72 [95% CI 1.13–2.62], P = 0.01, respectively). In model 2, a significantly higher adjusted OR than in the low CRP group was observed in the very high CRP group (1.61 [95% CI 1.05–2.45], P = 0.03).ConclusionsRelationships existed between elevated CRP levels and delirium.

Psychological symptoms of illness and emotional distress in advanced cancer cachexia

“…The study also showed that drowsiness was significantly worse with increasing CRP levels [3]. Delirium was diagnosed with the Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5), and drowsiness was estimated on the Japanese version of the Integrated Palliative care Outcome Scale (IPOS) [3]. The findings implied that the impact of systemic inflammation on the CNS might be one of the contributing factors to the genesis of psychological symptoms of illness.…”

“…The CNS is directly affected by inflammatory mediators in sickness, and the brain mediates cluster of behavioral changes (e.g., sleep disruption, cognitive impairment and memory deficits, disorientation, and reduction in motivated behavior) through communication systems between the immune system and the brain in humans and animals [20]. Other outcomes of sickness behavior, including weight loss (reduction of skeletal muscle mass and fat mass), increased catabolism (increased proteolysis and lipolysis), circadian rhythm disorders (disarrangement of eating habits and sleep-wake cycles), social disinterest, and sexual disinterest, appear to be a part of an integrated response of CNS and systemic inflammation [2,3,4 ▪▪ ,5,6,19,20].…”

“…There are potentially complex relationships within the overall symptom burden. Forexample, emotional distress can promote systemic inflammation and alter the CNS/HPA axis [3,6]. The complexities of relationships are illustrated in Fig.…”

“…Patients with cancer experience various symptoms of cachexia and these may be broadly characterized as physical (e.g., fever, pain) and psychological symptoms of illness (e.g., drowsiness, depression); these symptoms are summarized in Table 1[2,3,4 ▪▪ ,5]. The distinction (physical versus psychological) is not absolute and for example, anorexia and fatigue can arise as a direct consequence of tumor-induced neuro-inflammation but also can occur secondary to depressed mood.…”

“…An early event in cachexia with multiple ramifications seems to be inflammation of CNS, which may lead via a complex process to not only physical symptoms, but also psychological symptoms of illness. However, there is insufficient evidence showing that systemic inflammation acts through alternations in the CNS/ HPA axis in the genesis of psychological symptoms of illness among this population [2,3,4…”