Plasma melatonin levels in hip fracture patients with and without delirium: A confirmation study

Sep 1, 2017Mechanisms of ageing and development

Blood melatonin levels in hip fracture patients with and without delirium

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Circadian Biology on OpenScience ↗PubMed ↗DOI ↗

Abstract

High morning plasma melatonin concentrations were found in 389 samples from 144 hip fracture patients aged ≥65 years.

Increased melatonin levels were associated with postoperative samples, showing an Odds Ratio of 2.11 compared to preoperative samples.
Higher age was linked to elevated melatonin levels, with an Odds Ratio of 1.05 per year.
No significant association was observed between melatonin levels and the presence of delirium (p=0.35).
Changes in melatonin metabolism may occur due to surgery and aging.

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BACKGROUND: Melatonin plays a major role in maintaining circadian rhythm. Changes in melatonin metabolism might lead to circadian rhythm disturbances which are often observed in delirious patients.

AIM: To assess if high morning plasma melatonin concentrations were associated with delirium.

METHODS: Consecutive hip fracture patients aged ≥65 years were included. Delirium was assessed daily with the Confusion Assessment METHOD: Blood samples were collected at 11.00am on weekdays during first week of hospitalization. Melatonin was analyzed by liquid chromatography-tandem mass spectrometry.

RESULTS: We analyzed 389 samples of 144 participants [mean age 84.0, 70 experienced delirium]. A Generalized Estimating Equations (GEE) model with outcome melatonin level in highest tertile ( >3.36 pg/ml) and covariates delirium group (i.e. never, before, during, post delirium), cognitive impairment, age, sex and anesthesia type, was constructed. Highest melatonin levels were associated with postoperative samples (Odds Ratio(OR) 2.11 compared to preoperative samples; 95% Confidence Interval(CI) 1.17-3.82, p=0.01) and higher age (OR 1.05 per year; CI 1.01-1.11, p=0.03), but not with delirium group(p=0.35).

CONCLUSION: Undergoing surgery and aging in general may induce changes in melatonin metabolism. Future research should focus on daily multiple melatonin measurements to determine whether melatonin supplementation might be beneficial for delirium treatment or prevention.

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Plasma melatonin levels in hip fracture patients with and without delirium: A confirmation study

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