***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Suitable biomarkers associated with the development of delirium are still not known . Urinary proteomics has successfully been applied to identify novel biomarkers associated with various disease states , but its value has not been investigated in delirium patients . Results In a prospect i ve explorative study hyperactive delirium patients after cardiac surgery  were included for urinary proteomic analyses .  Delirium patients were matched with non-delirium patients after cardiac surgery  on age , gender , severity of illness score , LOS-ICU , Euro-score , C-reactive protein , renal function and aorta clamping time . Urine was collected within 24 hours after the onset of delirium . Matrix-assisted laser desorption/ionisation-time of flight mass spectrometry ( MALDI-TOF MS ) was applied to detect differences in the urinary proteome associated with delirium in these ICU patients . We included 10 hyperactive delirium and 10 meticulously matched non-delirium post-cardiac surgery patients . No relevant differences in the urinary excretion of proteins could be observed . Conclusions We conclude that MALDI-TOF MS of urine does not reveal a clear hyperactive delirium proteome fingerprint in ICU patients .Trial Registration Clinical Trial Register number : Animal research suggests that leptin may have an important role in the regulation of energy balance . The role of leptin in the progressive involuntary weight loss associated with cancer in humans is of considerable interest . However , such studies are limited . In this study , we compared circulating leptin concentrations in gastrointestinal cancer patients and weight loss ( n = 27 ) with those of healthy subjects ( n = 27 ) . The effect of the presence of an inflammatory response on leptin concentrations was also examined . There were significantly lower leptin concentrations in male ( median , 2.4 microg/liter ; range , < 0.5 - 6.0 microg/liter ) and female ( median , 3.4 microg/liter ; range , < 0.5 - 9.8 microg/liter ) cancer patients than there were in male ( median , 6.5 microg/liter ; range , 3.1 - 10.9 microg/liter ) and female ( median , 18.7 microg/liter ; range , 8.0 - 31.5 mcirog/liter ) healthy subjects ( P < 0.001 ) . However , the leptin concentrations in both patients and normal subjects were related to the predicted percentage of body fat ( r = 0.731 ; P < 0.001 ) . Circulating leptin concentrations in the cancer patients were not altered by the presence of an inflammatory response . These results suggest that cancer anorexia/cachexia is not due to a simple dysregulation of leptin production BACKGROUND Immunoregulatory cytokines may play a fundamental role in tumor growth and metastases . Their effects are mediated through complex regulatory networks . Human cytokine profiles could define patient subgroups and represent new potential biomarkers . The aim of this study was to associate a cytokine profile obtained through data mining with the clinical characteristics of patients with advanced non-small-cell lung cancer ( NSCLC ) . PATIENTS AND METHODS We conducted a prospect i ve study of the plasma levels of 14 immunoregulatory cytokines by ELISA and a cytometric bead array assay in 110 NSCLC patients before chemotherapy and 25 control subjects . Cytokine levels and data -mining profiles were associated with clinical , quality of life and pathological outcomes . RESULTS NSCLC patients had higher levels of interleukin (IL)-6 , IL-8 , IL-12p70 , IL-17a and interferon (IFN)-γ , and lower levels of IL-33 and IL-29 compared with controls . The pro-inflammatory cytokines IL-1b , IL-6 and IL-8 were associated with lower hemoglobin levels , worse functional performance status ( Eastern Cooperative Oncology Group , ECOG ) , fatigue and hyporexia . The anti-inflammatory cytokines IL-4 , IL-10 and IL-33 were associated with anorexia and lower body mass index . We identified three clusters of patients according to data -mining analysis with different overall survival ( OS ; 25.4 , 16.8 and 5.09 months , respectively , P = 0.0012 ) . Multivariate analysis showed that ECOG performance status and data -mining clusters were significantly associated with OS ( RR 3.59 , [ 95 % CI 1.9 - 6.7 ] , P < 0.001 and 2.2 , [ 1.2 - 3.8 ] , P = 0.005 ) . CONCLUSION Our results provide evidence that complex cytokine networks may be used to identify patient subgroups with different prognoses in advanced NSCLC . These cytokines may represent potential biomarkers , particularly in the immunotherapy era in cancer research Introduction The pathophysiology of sepsis-associated delirium is not completely understood and the data on cerebral perfusion in sepsis are conflicting . We tested the hypothesis that cerebral perfusion and selected serum markers of inflammation and delirium differ in septic patients with and without sepsis-associated delirium . Methods We investigated 23 adult patients with sepsis , severe sepsis , or septic shock with an extracranial focus of infection and no history of intracranial pathology . Patients were investigated after stabilisation within 48 hours after admission to the intensive care unit . Sepsis-associated delirium was diagnosed using the confusion assessment method for the intensive care unit .  Mean arterial pressure ( MAP ) , blood flow velocity ( FV ) in the middle cerebral artery using transcranial Doppler , and cerebral tissue oxygenation using near-infrared spectroscopy were monitored for 1 hour . An index of cerebrovascular autoregulation was calculated from MAP and FV data . C-reactive protein ( CRP ) , interleukin-6 ( IL-6 ) , S-100β , and cortisol were measured during each data acquisition . Results Data from 16 patients , of whom 12 had sepsis-associated delirium , were analysed . There were no significant correlations or associations between MAP , cerebral blood FV , or tissue oxygenation and sepsis-associated delirium . However , we found a significant association between sepsis-associated delirium and disturbed autoregulation ( P = 0.015 ) . IL-6 did not differ between patients with and without sepsis-associated delirium , but we found a significant association between elevated CRP ( P = 0.008 ) , S-100β ( P = 0.029 ) , and cortisol ( P = 0.011 ) and sepsis-associated delirium . Elevated CRP was significantly correlated with disturbed autoregulation ( Spearman rho = 0.62 , P = 0.010 ) . Conclusion In this small group of patients , cerebral perfusion assessed with transcranial Doppler and near-infrared spectroscopy did not differ between patients with and without sepsis-associated delirium . However , the state of autoregulation differed between the two groups . This may be due to inflammation impeding cerebrovascular endothelial function . Further investigations defining the role of S-100β and cortisol in the diagnosis of sepsis-associated delirium are warranted . Trial registration Clinical Trials.gov NCT00410111 Purpose Cancer cachexia and sarcopenia are frequently observed in cancer patients and associated with poor survival . The majority of studies of cancer cachexia and sarcopenia have been done in patients with solid tumors of different origins , and there are currently no good predictors of the benefit of chemotherapy or factors that predict survival in advanced cancer . The purpose of our prospect i ve study was to evaluate prevalence of cachexia and sarcopenia using international consensus definition and criteria for diagnosis in patients with diagnosed advanced non-small cell lung cancer ( NSCLC ) stage IIIB and IV and their relation to chemotherapy toxicity and survival prediction . A secondary aim was to compare several biochemical markers ( CRP , IL-6 , protein , and albumin ) with time to tumor progression in order to assess prognostic value or to guide a treatment . Methods Between December 2013 and April 2015 , the prospect i ve cohort study of 100 Caucasian patients with advanced NSCLC stage IIIB or IV , who were referred consecutively to Department for Respiratory Diseases “ Jordanovac , ” was evaluated . Anthropometric measurements and biochemical data ( CRP , albumin , protein , IL-6 , haemoglobin ) together with body composition measurements ( total muscle cross-sectional area , lumbar skeletal muscle index ) were obtained for each patient before starting with platinum-doublet therapy . Skeletal muscle cross-sectional area at the third lumbar vertebra was measured by computerized tomography , and sarcopenia was defined using a previously published cutoff point . Toxicity was assessed after cycle 1 of treatment and time-to-tumor progression was determined prospect ively . Results One hundred patients with advanced lung cancer were recruited : 67 were male and median age was 64 years . The median time to disease progression was 187 days . The prevalence of cachexia and sarcopenia in study cohort was 69 and 47 % , respectively . CRP , IL-6 , and albumin concentration in cachectic compared to non-cachectic patients demonstrated statistically significant difference ( p = 0.020 , p = 0.040 , p = 0.003 ) . Cachexia and sarcopenia were not found to be predictors of chemotoxicity nor was time to tumor progression . On the contrary , albumin concentration with established cutoff point of 37.5 g/L was clearly proved as the predictive factor of both chemotoxicity ( OR ( 95 % CI ) = 0.85 ; p < 0.001 ) and survival ( HR ( 95 % CI ) = 0.55 ) . Conclusions Albumin level has been shown to be more important predictive marker of chemotherapy toxicity and survival than cachexia and sarcopenia are . This approach in clinical setting s can be used to guide the choice of oncologic treatment Background The association between C‐reactive protein ( CRP ) level , symptoms , and activities of daily living ( ADL ) in advanced cancer patients is unclear . Methods Secondary data analysis of a multicenter prospect i ve cohort study consisted of 2426 advanced cancer patients referred to palliative care setting s was conducted to examine the cross‐sectional relationships between CRP level , symptoms , and ADL disabilities . Laboratory data , symptoms , ADL , and manual muscle testing ( MMT ) results were obtained at baseline . Participants were divided into four groups : low ( CRP < 1 mg/dl ) , moderate ( 1 = < CRP < 5 mg/dl ) , high ( 5 = < CRP < 10 mg/dl ) , and very high CRP ( 10 mg/dl = < CRP ) . The proportions of eight symptoms , five ADL disabilities , and three categories of MMT according to the CRP groups were tested by chi‐square tests . Multiple‐adjusted odd ratios ( ORs ) were calculated by using ordinal logistic regression after adjustment for age , gender , site of primary cancer , metastatic disease , performance status , chemotherapy , and setting of care . Results A total of 1702 patients were analysed . Positive rates of symptoms and ADL disabilities increased with increasing CRP level . In the very high‐CRP group , rates of positivity for anorexia , fatigue , and weight loss were 89.8 % , 81.0 % , and 79.2 % , respectively , and over 70 % of patients received assistance for bathing , dressing , going to the toilet , and transfer . The grade of MMT also deteriorated with increasing CRP level . Adjusted ORs for the accumulated symptoms significantly increased with increasing CRP level in the moderate‐CRP , high‐CRP , and very high‐CRP groups [ 1.6 ( 95 % confidence interval 1.2–2.0 ) , P < 0.001 ; 2.5 ( 1.9–3.2 ) , P < 0.001 ; 3.5 ( 2.7–4.6 ) , P < 0.001 , respectively ] . Adjusted ORs for the accumulated ADL disabilities significantly increased in the very high‐CRP groups [ 2.1 ( 1.5–2.9 ) , P < 0.001 ] . Conclusions Associations between CRP level , symptoms , and ADL were observed in advanced cancer patients receiving palliative care Purpose : Cancer cachexia is a devastating and understudied illness in patients with head and neck squamous cell carcinoma ( HNSCC ) . The primary objective was to identify clinical characteristics and serum levels of cytokines and cachexia-related factors in patients with HNSCC . The secondary objective was to detect the occurrence of cytokine and cachexia-related factor gene expression in HNSCC tumors . Experimental Design : For the primary objective , cross-sectional data were obtained from prospect ively recruited patients identified as cachexia cases and matching cachexia-free controls . For the secondary objective , a retrospective cohort design with matched controls was used . Results : Clinical characteristics associated with cancer cachexia in HNSCC were T4 status ( P = 0.01 ) , increased C-reactive protein ( P = 0.01 ) , and decreased hemoglobin ( P < 0.01 ) . Exploratory multiplex analysis of serum cytokine levels found increased interleukin (IL)-6 ( P = 0.04 ) . A highly sensitive ELISA confirmed the multiplex result for increased IL-6 in cachectic patients ( P = 0.02 ) . Quality of life was substantially reduced in 
    Output:
    
There is considerable overlap in the biomarkers in delirium and advanced cancer-related syndromes .
Improving the design of delirium biomarker studies and considering appropriate comparator/controls will help to better underst and ing the discrete pathophysiology of delirium in the context of co-existing illness