ORIGINAL ARTICLE

Relationship of albumin serum levels and Neutrophil-Lymphocyte Ratios (NLR) on activities of daily living elderly patients with delirium at Sanglah General Hospital, Bali, Indonesia

I Made Arya Winangun, I Gusti Putu Suka Aryana , I Nyoman Astika, Raden Ayu Tuty Kuswardhani

I Made Arya Winangun
Internal Medicine Department, Faculty of Medicine, Universitas Udayana, Sanglah General Hospital, Bali, Indonesia

I Gusti Putu Suka Aryana
Geriatric Division, Internal Medicine Department, Faculty of Medicine, Universitas Udayana, Sanglah General Hospital, Bali, Indonesia. Email: [email protected]

I Nyoman Astika
Geriatric Division, Internal Medicine Department, Faculty of Medicine, Universitas Udayana, Sanglah General Hospital, Bali, Indonesia

Raden Ayu Tuty Kuswardhani
Geriatric Division, Internal Medicine Department, Faculty of Medicine, Universitas Udayana, Sanglah General Hospital, Bali, Indonesia
Online First: April 01, 2020 | Cite this Article
Winangun, I., Aryana, I., Astika, I., Kuswardhani, R. 2020. Relationship of albumin serum levels and Neutrophil-Lymphocyte Ratios (NLR) on activities of daily living elderly patients with delirium at Sanglah General Hospital, Bali, Indonesia. Bali Medical Journal 9(1): 201-207. DOI:10.15562/bmj.v9i1.1639


Background: Delirium often occurs to the elderly, which is associated with inflammation, malnutrition and low activities of daily living (ADL). The reduced ADL is associated with poor outcomes and death. ADL is affected by malnutrition and inflammation. Albumin is a marker for malnutrition and inflammation, while the neutrophil-lymphocyte ratio (NLR) is a marker for inflammation. This study aims to determine the relationship between albumin serum levels and NLR to ADL in elderly delirium patients in Sanglah Hospital Denpasar.Methods: A cross-sectional correlative study among elderly delirium patients were conducted at Sanglah Hospital Denpasar from January to July 2018. The variables studied were albumin levels, NLR and ADL scores. Data analysis using SPSS version 23 with Pearson or Spearman correlation tests to determine the relationship between the variables examined.Results: Total of 73 patients were sampled. The average albumin levels were 3.35 gram/dL, the median NLR was 8.17 and the median ADL scores were 3. There was no significant relationship between albumin and ADL in elderly delirium patients (p=0.35, r=0.10), but a significant correlation was obtained between NLR and ADL scores (p=0.04, r=-0.24).Conclusion: Albumin did not significantly affect ADL. NLR was negatively correlated with ADL. The higher the NLR, the lower the ADL of elderly delirium patients.

 

Keywords


References

Cerveira CCT, Pupo CC, Santos SDS, Santos JEM. Delirium in the elderly: A systematic review of pharmacological and non-pharmacological treatments. Dement Neuropsychol. 2017;11(3):270-275.

Lima DP, Ochiai ME, Lima AB, Curiati JAE, Farfel JM, Filho WJ. Delirium in hospitalized elderly patients and post-discharge mortality. Clinics (Sao Paulo). 2010;65(3):251-255.

Adamis D, Treloar A, Darwiche FZ, Gregson N, Macdonald AJD, Martin FC. Association of delirium with in-hospital and in 6-months mortality in elderly medical inpatients. Age Ageing. 2007;36(6):644-649.

Egberts A, Mattace-Raso FU. Increased neutrophil-lymphocyte ratio in delirium: a pilot study. Clin Interv Aging. 2017;12:1115-1121.

Soejono CH. Sindrom Delirium (Acute Confusional State). In: Buku Ajar Ilmu Penyakit Dalam Jilid III, 6th Edition: Siti Setiati et al (editors). Jakarta: Interna Publishing. 2015. p. 3798-3803.

Kuswardhani T, Sugi YS. Factors Related to the Severity of Delirium in the Elderly Patients with Infection. Gerontol Geriatr Med. 2017;3:1-5

Katz PP. Measures of Adult General Functional Status: The Barthel Index, Katz Index of Activities of Daily Living, Health Assessment Questionnaire (HAQ), MACTAR Patient Preference Disability Questionnaire, and Modified Health Assessment Questionnaire (MHAQ). Arthritis & Rheumatism (Arthritis Care & Research). 2003;49(S5):15-27.

Mlinac ME, Feng MC. Assessment of Activities of Daily Living, Self-Care, and Independence. Arch Clin Neuropsychol. 2016;31(6):506-516.

Hsu HY, Hwang LC, Lin CH, Lin CJ, Tjung JJ. Impact of Serum Albumin on Functional Status and Hospital Outcome in Oldest-Old Inpatients. International Journal of Gerontology. 2015;9(4):220-222.

Cabrerizo S, Cuadras D, Gomez-Busto F, Artaza-Artabe I, Marin-Ciancas F, Malafarina V. Serum Albumin and Health in Older People: Review and Meta Analysis. Maturitas. 2015:8(1):17-27.

Villafane JH, Pirali C, Dughi S, Testa A, Manno S, Bishop MD, et al. Association between malnutrition and Barthel Index in a cohort of hospitalized older adults article information. J Phys Ther Sci. 2016;28(2):607-12.

Liu JYJ, Reijnierse EM, Ancum JMV, Verlaan S, Meskers CGM, Maier AB. Acute inflammation is associated with lower muscle strength, muscle mass and functional dependency in male hospitalised older patients. PLoS One. 2019;14(4): e0215097

Sugita Y, Miyazaki T, Shimada K, Shimizu M, Kunimoto M, Ouchi S, et al. Correlation of Nutritional Indices on Admission to the Coronary Intensive Care Unit with the Development of Delirium. Nutrients. 2018;10(11):1-12.

Bharadwaj S, Ginoya S, Tandon P, Gohel TD, Guirguis J, Vallabh H, Jevenn A, Hanouneh I. Malnutrition: Laboratory Markers vs Nutritional Assessment. Gastroenterol Rep (Oxf). 2016;4(4):272-280.

Prabawa IPY, Bhargah A, Liwang F, Tandio DA, Tandio AL, Lestari AAW, et al. Pretreatment Neutrophil-to-Lymphocyte ratio (NLR) and Platelet-to-Lymphocyte Ratio (PLR) as a Predictive Value of Hematological Markers in Cervical Cancer. Asian Pac J Cancer Prev. 2019;20(3):863-868.

Kim H, Chung S, Joo YH, Lee JS. The major risk factors for delirium in a clinical setting. Neuropsychiatr Dis Treat. 2016;12:1787-93.

Putri TL, Ganie RA, Rambe AS. Neutrophil-Lymphocyte Ratio and High Sensitivity C-Reactive Protein as Ischemic Stroke Outcome Predictor. Indonesian Journal of Clinical Pathology and Medical Laboratory. 2017;23(3):240-245.

Vietara DW. Uji Kesahihan dan Keandalan Algoritma Confusion Assessment Method sebagai Instrumen Penapis Delirium Lanjut Usia di Instalasi Gawat Darurat RSUPN Dr. Ciptomangunkusumo [Thesis]. Universitas Indonesia. 2012.

Levitt DG, Levitt MD. Human Serum Albumin Homeostasis: A New Look at the Roles of Synthesis, Catabolism, Renal and Gastrointestinal Excretion, and the Clinical Value of Serum Albumin Measurements. Int J Gen Med. 2016;9:229-55.

Kitamura K, Nakamura K, Nishiwaki T, Ueno K, Nakazawa A, Hasegawa M. Determination of whether the Association between Serum Albumin and Activities of Daily Living in Frail Eldery People is Casual. Environ Health Prev Med. 2012;17(2):164-168.

Djordjevik D, Rondovic G, Surbatovik M, Stanojevic I, Udovicic I, Andjelic T, et al. Neutrophil-to-Lymphocyte Ratio, Monocyte-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio and Mean Platelet Volume-to-Platelet Count Ratio as Biomarkers in Critically Ill and Injured Patients: Which ratio to Choose to Predict Outcome and Nature of Bacteremia?. Mediators Inflamm. 2018:1-15.


No Supplementary Material available for this article.
Article Views      : 0
PDF Downloads : 0