LAUSR

Background: Delirium occurs frequently in patients with intracerebral hemorrhage (ICH), though its pathogenesis may be multifactorial. Given the potential role of systemic stressors in delirium, we aimed to explore differences in commonly measured markers of physiologic stress between delirious and non-delirious ICH patients. Methods: We performed a single-center cohort study using data from consecutive non-comatose ICH patients over 12 months. ICH and patient characteristics were prospectively collected, and the presence of delirium at any point during hospitalization was diagnosed based on DSM-5 criteria. We retrospectively abstracted admission laboratory values and selected three common markers of physiologic stress for comparison: neutrophil-lymphocyte ratio (NLR), troponin, and glucose. Using multivariable models adjusted for demographics, relevant comorbidities, and ICH severity, we determined associations between delirium and the following: NLR, using linear regression; elevated troponin (>0.05 ng/mL), using binary logistic regression; and elevated glucose (categorized as 130-180 or >180 mg/dL), using ordered logistic regression. Results: Of 284 ICH patients in our cohort, 55% (n=157) had delirium. Patients with delirium were not significantly older than non-delirious patients (mean age 71.7±16.2 vs. 68.3±15.1, p=0.07), but had larger ICH volumes (mean 23.3±24.6 vs. 7.0±10.6 cc, p<0.001) and were more likely to have intraventricular hemorrhage (55% vs. 22%, p<0.001). Delirious patients also had higher admission NLR (mean 9.0±10.4 vs. 6.4±5.5, p=0.01) and glucose (mean 146.5±59.6 vs. 129.9±41.4 mg/dL, p=0.008), and were more likely to have elevated troponin (21% vs. 10%, p=0.02). In adjusted models, patients with delirium had higher admission NLR than patients who were never delirious (adjusted mean difference 2.6, 95% CI 0.3-4.9), and were more likely to have elevated admission troponin (OR 2.8, 95% CI 1.2-6.4) and glucose (OR 2.0, 95% CI 1.1-3.6). Conclusions: Delirium after ICH is independently associated with elevated serum markers of physiologic stress, suggesting that systemic factors may be implicated in delirium pathogenesis.