中文｜English
ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 40 Issue 9
Sep.  2024
Turn off MathJax
Article Contents
Article Navigation >  Journal of Clinical Hepatology  > 2024  >  40(9): 1816-1821

Construction and validation of a risk prediction model for postoperative delirium in primary liver cancer patients aged 60 years or older

DOI: 10.12449/JCH240916

  • Department of Anesthesiology，Tianyou Hospital Affiliated to Wuhan University of Science and Technology，Wuhan 430062，China

Research funding:

Hubei Key Laboratory Open Project (2022ESOF009)

  • Received Date: 2023-09-12
  • Accepted Date: 2023-10-24
  • Published Date: 2024-09-25
    Abstract
  •   Objective  To construct a risk prediction model for postoperative delirium in elderly patients with primary liver cancer， and to validate its application value.  Methods  A retrospective analysis was performed for 175 elderly patients with primary liver cancer who were admitted to Tianyou Hospital Affiliated to Wuhan University of Science and Technology from March 2020 to January 2023. The incidence rate of postoperative delirium was recorded， and the univariate and multivariate regression analyses was performed for factors that may affect the onset of delirium. A prediction model was constructed， and the clinical application value of the prediction model was analyzed and validated. The independent-samples t test was used for comparison of continuous data between two groups， and the chi-square test was used for comparison of categorical data between two groups. The univariate and multivariate logistic regression analyses were performed for factors that may affect the onset of delirium in elderly patients with primary liver cancer， and the receiver operating characteristic （ROC） curve was used to investigate the value of the model in predicting the onset of delirium.  Results  Among the 175 elderly patients with primary liver cancer， 41 experienced postoperative delirium， with an incidence rate of 23.43%. The univariate analysis showed that age， presence of more than two underlying diseases， Child-Pugh class of liver function， preoperative blood lactate， time of operation， preoperative hemoglobin， and preoperative serum albumin were associated with the onset of postoperative delirium （t=3.534， χ2=12.000， χ2=4.938， t=7.561， t=5.768， t=5.141， t=6.148， P<0.05）. The multivariate logistic regression analysis of the factors with statistical significance in the univariate analysis showed that time of operation， preoperative hemoglobin， preoperative serum albumin， and age were included in the regression model （P<0.05）， and they were independent risk factors for the onset of postoperative delirium in elderly patients with primary liver cancer. According to the results of the multivariate logistic regression analysis， a prediction model for postoperative delirium in elderly patients with primary liver cancer was constructed as follows： -2.222+3.678×time of operation－2.441×preoperative hemoglobin－3.904×preoperative serum albumin+1.807×age. The prediction performance of this model was analyzed， with an area under the ROC curve of 0.931 （95% confidence interval： 0.890 ‍—‍ 0.971， P<0.001） and an optimal cut-off value of -1.604 （with a sensitivity of 87.80% and a specificity of 87.30%）. A total of 56 elderly patients with primary liver cancer who underwent radical surgery in Tianyou Hospital Affiliated to Wuhan University of Science and Technology from February 2023 to June 2023 were enrolled in a prospective study for model validation. According to the above risk prediction model， there were 14 patients in the high-risk group and 42 patients in the low-risk group， and the high-risk group had a significantly higher incidence rate of postoperative delirium than the low-risk group （71.43% vs 11.90%， χ²=16.056， P<0.05）.  Conclusion  Age， time of operation， preoperative serum albumin， and preoperative hemoglobin are important influencing factors for the onset of postoperative delirium in elderly patients with primary liver cancer. The risk prediction model based on these factors has a good prediction performance， which holds promise for further in-depth research.

     

    • FullText(HTML)
  • loading
    • References(22)
  • [1]
    LUETZ A, GRUNOW JJ, MÖRGELI R, et al. Innovative ICU solutions to prevent and reduce delirium and post-intensive care unit syndrome[J]. Semin Respir Crit Care Med, 2019, 40( 5): 673- 686. DOI: 10.1055/s-0039-1698404.
    [2]
    WANG J, SHUANG PZ, ZHAO LB, et al. Risk factors of postoperative delirium in elderly patients undergoing hip fracture repair surgery[J]. J Clin Anesthesiol, 2023, 39( 3): 235- 240. DOI: 10.12089/jca.2023.03.002.

    王洁, 双鹏展, 赵龙彪, 等. 老年患者髋部骨折修复术后谵妄的危险因素[J]. 临床麻醉学杂志, 2023, 39( 3): 235- 240. DOI: 10.12089/jca.2023.03.002.
    [3]
    LI XP, WANG L, ZHANG H, et al. Construction and evaluation of a risk prediction model of postoperative delirium in patients with Stanford type A aortic dissection[J]. Chin J Nurs, 2022, 57( 8): 950- 957. DOI: 10.3761/j.issn.0254-1769.2022.08.009.

    李雪苹, 王磊, 张淮, 等. Stanford A型主动脉夹层患者术后谵妄风险预测评分模型的构建与效果验证[J]. 中华护理杂志, 2022, 57( 8): 950- 957. DOI: 10.3761/j.issn.0254-1769.2022.08.009.
    [4]
    YIN SL, SHI Y, CUI H, et al. Correlation between preoperative insomnia subtypes and postoperative delirium in elderly patients[J]. Anhui Med J, 2023, 44( 3): 314- 320. DOI: 10.3969/j.issn.1000-0399.2023.03.015.

    尹世梁, 施源, 崔虎, 等. 老年患者术前失眠障碍亚型与术后谵妄的相关性[J]. 安徽医学, 2023, 44( 3): 314- 320. DOI: 10.3969/j.issn.1000-0399.2023.03.015.
    [5]
    KRINITSKI D, KASINA R, KLÖPPEL S, et al. Associations of delirium with urinary tract infections and asymptomatic bacteriuria in adults aged 65 and older: A systematic review and meta-analysis[J]. J Am Geriatr Soc, 2021, 69( 11): 3312- 3323. DOI: 10.1111/jgs.17418.
    [6]
    BAHJI A, BACH P, DANILEWITZ M, et al. Comparative efficacy and safety of pharmacotherapies for alcohol withdrawal: A systematic review and network meta-analysis[J]. Addiction, 2022, 117( 10): 2591- 2601. DOI: 10.1111/add.15853.
    [7]
    National Health and Family Planning Commission, People’s Republic of China. Diagnosis, management, and treatment of hepatocellular carcinoma(V2017)[J]. J Clin Hepatol, 2017, 33( 8): 1419- 1431. DOI: 10.3969/j.issn.1001-5256.2017.08.003.

    中华人民共和国国家卫生和计划生育委员会. 原发性肝癌诊疗规范(2017年版)[J]. 临床肝胆病杂志, 2017, 33( 8): 1419- 1431. DOI: 10.3969/j.issn.1001-5256.2017.08.003.
    [8]
    MARGIOTTA A, BIANCHETTI A, RANIERI P, et al. Clinical characteristics and risk factors of delirium in demented and not demented elderly medical inpatients[J]. J Nutr Health Aging, 2006, 10( 6): 535- 539.
    [9]
    LIU QG, SONG T, WANG HH. Re-understanding of surgical resection techniques for liver cancer[J]. Chin J Dig Surg, 2024, 23( 1): 75- 79. DOI: 10.3760/cma.j.cn115610-20231214-00253.

    刘青光, 宋涛, 王欢欢. 肝癌外科手术切除技术的再认识[J]. 中华消化外科杂志, 2024, 23( 1): 75- 79. DOI: 10.3760/cma.j.cn115610-20231214-00253.
    [10]
    XU R, HUA Z. Epidemiological characteristics, risk factors and related preventive intervention strategies for cirrhosis complicated with primary liver cancer[J]. Chin J Integr Tradit West Med Liver Dis, 2020, 30( 4): 357- 359, 366. DOI: 10.3969/j.issn.1005-0264.2020.04.021.

    徐蓉, 华忠. 肝硬化并发原发性肝癌的流行病学特征、危险因素及相预防干预对策研究[J]. 中西医结合肝病杂志, 2020, 30( 4): 357- 359, 366. DOI: 10.3969/j.issn.1005-0264.2020.04.021.
    [11]
    ZHANG WL, LOU JS, SONG YX, et al. Research advances in application of biomarkers in diagnosis and treatment of postoperative delirium in elderly patients[J]. Acad J Chin PLA Med Sch, 2023, 44( 2): 197- 200. DOI: 10.3969/j.issn.2095-5227.2023.02.018.

    张伟丽, 娄景盛, 宋玉祥, 等. 生物标志物在老年患者术后谵妄诊疗中的应用综述[J]. 解放军医学院学报, 2023, 44( 2): 197- 200. DOI: 10.3969/j.issn.2095-5227.2023.02.018.
    [12]
    WILDES TS, MICKLE AM, ABDALLAH A BEN, et al. Effect of electroencephalography-guided anesthetic administration on postoperative delirium among older adults undergoing major surgery: The ENGAGES randomized clinical trial[J]. JAMA, 2019, 321( 5): 473- 483. DOI: 10.1001/jama.2018.22005.
    [13]
    XU YN, MA QQ, DU HM, et al. Postoperative delirium in neurosurgical patients: Recent insights into the pathogenesis[J]. Brain Sci, 2022, 12( 10): 1371. DOI: 10.3390/brainsci12101371.
    [14]
    YANG JJ, LEI L, QIU D, et al. Effect of remimazolam on postoperative delirium in older adult patients undergoing orthopedic surgery: A prospective randomized controlled clinical trial[J]. Drug Des Devel Ther, 2023, 17: 143- 153. DOI: 10.2147/DDDT.S392569.
    [15]
    SUMNER M, DENG C, EVERED L, et al. Processed electroencephalography-guided general anaesthesia to reduce postoperative delirium: A systematic review and meta-analysis[J]. Br J Anaesth, 2023, 130( 2): e243- e253. DOI: 10.1016/j.bja.2022.01.006.
    [16]
    WU D, LI JQ, YUAN H, et al. Effect of dexmedetomidine on postoperative delirium and cerebral oxygen metabolism in elderly patients undergoing pulmonary surgery[J]. China J Mod Med, 2022, 32( 14): 71- 76. DOI: 10.3969/j.issn.1005-8982.2022.14.013.

    吴迪, 李俊青, 袁浩, 等. 右美托咪定对老年肺部手术患者术后谵妄发生率、脑氧代谢的影响[J]. 中国现代医学杂志, 2022, 32( 14): 71- 76. DOI: 10.3969/j.issn.1005-8982.2022.14.013.
    [17]
    FU HM, ZHONG CC, ZHOU WW, et al. Effect of acute normovolemic hemodilution on postoperative delirium and inflammation in elderly patients undergoing total hip arthroplasty[J]. J Clin Anesthesiol, 2021, 37( 6): 583- 587. DOI: 10.12089/jca.2021.06.005.

    付慧敏, 钟超超, 周伟伟, 等. 急性等容血液稀释对老年患者全髋关节置换术后谵妄和炎症水平的影响[J]. 临床麻醉学杂志, 2021, 37( 6): 583- 587. DOI: 10.12089/jca.2021.06.005.
    [18]
    ZHANG H, LI SP. Analysis of the current status of delirium in elderly patients after hip replacement and its related influencing factors[J]. J Changchun Univ Chin Med, 2022, 38( 10): 1155- 1159. DOI: 10.13463/j.cnki.cczyy.2022.10.022.

    张宏, 李淑萍. 老年患者髋关节置换术后谵妄的发生现状及其相关影响因素分析[J]. 长春中医药大学学报, 2022, 38( 10): 1155- 1159. DOI: 10.13463/j.cnki.cczyy.2022.10.022.
    [19]
    AHRENS E, TARTLER TM, SULEIMAN A, et al. Dose-dependent relationship between intra-procedural hypoxaemia or hypocapnia and postoperative delirium in older patients[J]. Br J Anaesth, 2023, 130( 2): e298- e306. DOI: 10.1016/j.bja.2022.08.032.
    [20]
    TAYLOR J, PAYNE T, CASEY C, et al. Sevoflurane dose and postoperative delirium: A prospective cohort analysis[J]. Br J Anaesth, 2023, 130( 2): e289- e297. DOI: 10.1016/j.bja.2022.08.022.
    [21]
    SUN GQ, ZHOU SL, ZENG TL, et al. Expression of calcitonin gene-related peptide-receptor component protein in hepatocellular carcinoma and its association with prognosis[J]. J Clin Hepatol, 2022, 38( 6): 1328- 1333. DOI: 10.3969/j.issn.1001-5256.2022.06.021.

    孙冠群, 周思蕾, 曾榃伦, 等. 降钙素基因相关肽受体成分蛋白在肝细胞癌中的表达及其与预后的关系[J]. 临床肝胆病杂志, 2022, 38( 6): 1328- 1333. DOI: 10.3969/j.issn.1001-5256.2022.06.021.
    [22]
    HAN LY, GAO CJ. Anesthetic effect of different doses of esketamine in radical thyroidectomy and its influence on early postoperative emotional response[J]. Shandong Med J, 2023, 63( 2): 71- 75. DOI: 10.3969/j.issn.1002-266X.2023.02.018.

    韩礼业, 高成杰. 不同剂量艾司氯胺酮在甲状腺癌根治术中的麻醉效果及对术后早期情绪反应的影响[J]. 山东医药, 2023, 63( 2): 71- 75. DOI: 10.3969/j.issn.1002-266X.2023.02.018.
    • Relative Articles
    • Supplements(0)
    • Cited By
  • 加载中

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Figures(2)  / Tables(4)

    Get Citation
    PDF
    XML

    Article Metrics

    Article views (45) PDF downloads(8) Cited by()
    Proportional views
    Related
        

    The first journal specializing in hepatobiliary and pancreatic diseases in China

    Supervisor：Ministry of Education of the People's Republic of China

    Sponsor：Jilin University

    Academic Support: Chinese Society of Hepatology，Chinese Medical Association

    Address: 461 Xinjiang Road, Changchun

    Submit：0431-88782044

    Peer review：0431-88783542

    Email：lcgdb@vip.163.com

    About Journal

    Submission Guideline

    Journal Online

    Hepatobiliary College

    Guidelines

    YesterdayIP[]YesterdayPV[]TodayIP[]TodayPV[]Online[]

    Website Design © 2020 Editorial Board of Journal of Clinical Hepatology 吉ICP备10000617号-1 Supported by: Beijing Renhe Information Technology Co. Ltd  

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return