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Song C, Yu D, Li Y, Liu M, Zhang H, He J, Li J. Predictive value of the Naples prognostic score on postoperative delirium in the elderly with gastrointestinal tumors: a retrospective cohort study. BMC Geriatr 2024; 24:535. [PMID: 38902614 PMCID: PMC11188257 DOI: 10.1186/s12877-024-05113-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 05/28/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND Postoperative delirium (POD) is a common complication among elderly patients after surgery. The Naples Prognostic Score (NPS), a novel prognostic marker based on immune-inflammatory and nutritional status, was widely used in the assessment of the prognosis of surgical patients. However, no study has evaluated the relationship between NPS and POD. The aim of this article was to investigate the association between NPS and POD and test the predictive efficacy of preoperative NPS for POD in elderly patients with gastrointestinal tumors. MATERIALS AND METHODS In the present study, we retrospectively collected perioperative data of 176 patients (≥ 60 years) who underwent elective gastrointestinal tumor surgery from June 2022 to September 2023. POD was defined according to the chart-based method and the NPS was calculated for each patient. We compared all the demographics and laboratory data between POD and non-POD groups. Univariate and multivariate logistic regression analysis was used to explore risk factors of POD. Moreover, the accuracy of NPS in predicting POD was further assessed by utilizing receiver operating characteristic (ROC) curves. RESULTS 20 had POD (11.4%) in a total of 176 patients, with a median age of 71 (65-76). The outcomes by univariate analysis pointed out that age, ASA status ≥ 3, creatinine, white blood cell count, fasting blood glucose (FBG), and NPS were associated with the risk of POD. Multivariate logistic regression analysis further showed that age, ASA grade ≥ 3, FBG and NPS were independent risk factors of POD. Additionally, the ROC curves revealed that NPS allowed better prognostic capacity for POD than other variables with the largest area under the curve (AUC) of 0.798, sensitivity of 0.800 and specificity of 0.667, respectively. CONCLUSION Age, ASA grade ≥ 3, and FBG were independent risk factors for POD in the elderly underwent gastrointestinal tumor surgery. Notably, the preoperative NPS was a more effective tool in predicting the incidence of POD, but prospective trials were still needed to further validate our conclusion. TRIAL REGISTRATION The registration information for the experiment was shown below. (date: 3rd January 2024; number: ChiCTR2400079459).
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Affiliation(s)
- Chenhao Song
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, Hebei Province, 050051, China
| | - Dongdong Yu
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, Hebei Province, 050051, China
| | - Yi Li
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, Hebei Province, 050051, China
| | - Meinv Liu
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, Hebei Province, 050051, China
| | - Huanhuan Zhang
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, Hebei Province, 050051, China
| | - Jinhua He
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, Hebei Province, 050051, China
| | - Jianli Li
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, Hebei Province, 050051, China.
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Yan M, Lin Z, Zheng H, Lai J, Liu Y, Lin Z. Development of an individualized model for predicting postoperative delirium in elderly patients with hepatocellular carcinoma. Sci Rep 2024; 14:11716. [PMID: 38777824 PMCID: PMC11111779 DOI: 10.1038/s41598-024-62593-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 05/20/2024] [Indexed: 05/25/2024] Open
Abstract
Postoperative delirium (POD) is a common complication in older patients with hepatocellular carcinoma (HCC) that adversely impacts clinical outcomes. We aimed to evaluate the risk factors for POD and to construct a predictive nomogram. Data for a total of 1481 older patients (training set: n=1109; validation set: n=372) who received liver resection for HCC were retrospectively retrieved from two prospective databases. The receiver operating characteristic (ROC) curve, calibration plot, and decision curve analysis (DCA) were used to evaluate the performance. The rate of POD was 13.3% (148/1109) in the training set and 16.4% (61/372) in the validation set. Multivariate analysis of the training set revealed that factors including age, history of cerebrovascular disease, American Society of Anesthesiologists (ASA) classification, albumin level, and surgical approach had significant effects on POD. The area under the ROC curves (AUC) for the nomogram, incorporating the aforementioned predictors, was 0.798 (95% CI 0.752-0.843) and 0.808 (95% CI 0.754-0.861) for the training and validation sets, respectively. The calibration curves of both sets showed a degree of agreement between the nomogram and the actual probability. DCA demonstrated that the newly established nomogram was highly effective for clinical decision-making. We developed and validated a nomogram with high sensitivity to assist clinicians in estimating the individual risk of POD in older patients with HCC.
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Affiliation(s)
- Mingfang Yan
- Department of Anesthesiology, Clinical Oncology School of Fujian Medical University &, Fujian Cancer Hospital, Fuzhou, 350014, Fujian, China
| | - Zhaoyan Lin
- College of Animal Science, Fujian Agriculture and Forestry University, Fuzhou, 350002, Fujian, China
| | - Huizhe Zheng
- Department of Anesthesiology, Clinical Oncology School of Fujian Medical University &, Fujian Cancer Hospital, Fuzhou, 350014, Fujian, China
| | - Jinglan Lai
- Department of Infectious Diseases, Mengchao Hepatobiliary Hospital of Fujian. Medical University, Fuzhou, 350025, Fujian, China
| | - Yuming Liu
- Department of Anesthesiology, Mengchao Hepatobiliary Hospital of Fujian. Medical University, Fuzhou, 350025, Fujian, China.
| | - Zhenmeng Lin
- Department of Anesthesiology, Clinical Oncology School of Fujian Medical University &, Fujian Cancer Hospital, Fuzhou, 350014, Fujian, China.
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Sheng W, Tang X, Hu X, Liu P, Liu L, Miao H, Wang D, Li T. Random forest algorithm for predicting postoperative delirium in older patients. Front Neurol 2024; 14:1325941. [PMID: 38274882 PMCID: PMC10808713 DOI: 10.3389/fneur.2023.1325941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 12/29/2023] [Indexed: 01/27/2024] Open
Abstract
Objective In this study, we were aimed to identify important variables via machine learning algorithms and predict postoperative delirium (POD) occurrence in older patients. Methods This study was to make the secondary analysis of data from a randomized controlled trial. The Boruta function was used to screen relevant basic characteristic variables. Four models including Logistic Regression (LR), K-Nearest Neighbor (KNN), the Classification and Regression Tree (CART), and Random Forest (RF) were established from the data set using repeated cross validation, hyper-parameter optimization, and Smote technique (Synthetic minority over-sampling technique, Smote), with the calculation of confusion matrix parameters and the plotting of Receiver operating characteristic curve (ROC), Precision recall curve (PRC), and partial dependence graph for further analysis and evaluation. Results The basic characteristic variables resulting from Boruta screening included grouping, preoperative Mini-Mental State Examination(MMSE), CHARLSON score, preoperative HCT, preoperative serum creatinine, intraoperative bleeding volume, intraoperative urine volume, anesthesia duration, operation duration, postoperative morphine dosage, intensive care unit (ICU) duration, tracheal intubation duration, and 7-day postoperative rest and move pain score (median and max; VAS-Rest-M, VAS-Move-M, VAS-Rest-Max, and VAS-Move-Max). And Random Forest (RF) showed the best performance in the testing set among the 4 models with Accuracy: 0.9878; Matthews correlation coefficient (MCC): 0.8763; Area under ROC curve (AUC-ROC): 1.0; Area under the PRC Curve (AUC-PRC): 1.0. Conclusion A high-performance algorithm was established and verified in this study demonstrating the degree of POD risk changes in perioperative elderly patients. And the major risk factors for the development of POD were CREA and VAS-Move-Max.
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Affiliation(s)
- Weixuan Sheng
- Department of Anesthesiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Xianshi Tang
- Key Laboratory of National Health Commission on Parasitic Disease Control and Prevention, Key Laboratory of Jiangsu Province on Parasite and Vector Control Technology, Jiangsu Institute of Parasitic Diseases, Wuxi, China
| | - Xiaoyun Hu
- Department of Anesthesiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Pengfei Liu
- Department of Anesthesiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Lei Liu
- Department of Science and Technology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Huihui Miao
- Department of Anesthesiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Dongxin Wang
- Department of Anesthesiology, Peking University First Hospital, Beijing, China
| | - Tianzuo Li
- Department of Anesthesiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
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Dong B, Yu D, Jiang L, Liu M, Li J. Incidence and risk factors for postoperative delirium after head and neck cancer surgery: an updated meta-analysis. BMC Neurol 2023; 23:371. [PMID: 37848819 PMCID: PMC10580509 DOI: 10.1186/s12883-023-03418-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 10/03/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Postoperative delirium (POD) is a frequent neurologic dysfunction that often leads to more negative outcomes. Early identification of patients who are vulnerable to POD and early implementation of appropriate management strategies could decrease its occurrence and improve patient prognosis. Therefore, this meta-analysis comprehensively and quantitatively summarized the prevalence and related predictive factors of POD in head and neck cancer surgical patients. METHODS PubMed, Embase, and Cochrane Library were searched for observational studies that reported the prevalence and risk factors for POD after head and neck cancer surgery and were published from their inception until December 31, 2022. Two reviewers independently selected qualified articles and extracted data. The qualities of related papers were assessed using the Newcastle-Ottawa scale (NOS). RevMan 5.3 and Stata 15.0 were applied to analysis the data and conduct the meta-analysis. RESULTS Sixteen observational studies with 3289 inpatients who underwent head and neck cancer surgery were included in this review. The occurrence of POD ranged from 4.2 to 36.9%, with a pooled incidence of 20% (95% CI 15-24%, I2 = 93.2%). The results of this pooled analysis demonstrated that the statistically significant risk factors for POD were increased age (OR: 1.05, 95% CI: 1.03-1.07, P < 0.001), age > 75 years (OR: 6.52, 95% CI: 3.07-13.87, P < 0.001), male sex (OR: 2.29, 95% CI: 1.06-4.97, P = 0.04), higher American Society of Anesthesiologists grade (OR: 2.19, 95% CI: 1.44-3.33, P < 0.001), diabetes mellitus (OR: 2.73, 95% CI: 1.24-6.01, P = 0.01), and history of smoking (OR: 2.74, 95% CI: 1.13-6.65, P = 0.03). CONCLUSIONS POD frequently occurs after head and neck cancer surgery. Several independent predictors for POD were identified, which might contribute to identifying patients at high risk for POD and play a prominent role in preventing POD in patients following head and neck cancer surgery.
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Affiliation(s)
- Bo Dong
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang city, China
| | - Dongdong Yu
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang city, China
| | - Li Jiang
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang city, China
| | - Meinv Liu
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang city, China
| | - Jianli Li
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang city, China.
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Raos D, Prkačin I, Delalić Đ, Bulum T, Lovrić Benčić M, Jug J. Postoperative Hyperuricemia-A Risk Factor in Elective Cardiosurgical Patients. Metabolites 2023; 13:metabo13050590. [PMID: 37233631 DOI: 10.3390/metabo13050590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/23/2023] [Accepted: 04/24/2023] [Indexed: 05/27/2023] Open
Abstract
Hyperuricemia is a well-known cardiovascular risk factor. The aim of our study was to investigate the connection between postoperative hyperuricemia and poor outcomes after elective cardiac surgery compared to patients without postoperative hyperuricemia. In this retrospective study, a total of 227 patients after elective cardiac surgery were divided into two groups: 42 patients with postoperative hyperuricemia (mean age 65.14 ± 8.9 years) and a second group of 185 patients without it (mean age 62.67 ± 7.45 years). The time spent on mechanical ventilation (hours) and in the intensive care unit (days) were taken as the primary outcome measures while the secondary measure comprised postoperative complications. The preoperative patient characteristics were similar. Most of the patients were men. The EuroSCORE value of assessing the risk was not different between the groups nor the comorbidities. Among the most common comorbidities was hypertension, seen in 66% of all patients (69% in patients with postoperative hyperuricemia and 63.7% in those without it). A group of patients with postoperative hyperuricemia had a prolonged time of treatment in the intensive care unit (p = 0.03), as well as a prolonged duration of mechanical ventilation (p < 0.01) and a significantly higher incidence of the following postoperative complications: circulatory instability and/or low cardiac output syndrome (LCOS) (χ2 = 4486, p < 0.01), renal failure and/or continuous venovenous hemodiafiltration (CVVHDF's) (χ2 = 10,241, p < 0.001), and mortality (χ2 = 5.22, p < 0.01). Compared to patients without postoperative hyperuricemia, elective cardiac patients with postoperative hyperuricemia have prolonged postoperative treatment in intensive care units, extended durations of mechanically assisted ventilation, and a higher incidence of postoperative circulatory instability, renal failure, and death.
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Affiliation(s)
- Dominik Raos
- Institute of Emergency Medicine of Zagreb County, 10000 Zagreb, Croatia
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Ingrid Prkačin
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Department of Internal Medicine, Merkur University Hospital, 10000 Zagreb, Croatia
| | - Điđi Delalić
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Tomislav Bulum
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Department of Diabetes, Vuk Vrhovac University Clinic for Diabetes, Endocrinology, and Metabolic Diseases, Merkur University Hospital, 10000 Zagreb, Croatia
| | - Martina Lovrić Benčić
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Department for Ischemic Heart Disease, University Clinic of Cardiovascular Diseases, Clinical Hospital Center Zagreb, 10000 Zagreb, Croatia
| | - Juraj Jug
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Health Center Zagreb-West, 10000 Zagreb, Croatia
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