Department of Cardiovascular Surgery, Fujian Medical University Affiliated First Quanzhou Hospital, Quanzhou, China.
Heart Surg Forum. 2021 Mar 30;24(2):E320-E326. doi: 10.1532/hsf.3551.
Cardiac postoperative cognitive dysfunction (c-POCD) is a common complication. This article established a nomogram by analyzing preoperative and intraoperative data to help identify high-risk patients and take effective management for prevention of c-POCD in early stage.
A total of 265 patients were enrolled in this study, 27 of whom were diagnosed as cardiac postoperative cognitive dysfunction (c-POCD). Patients were divided into a control group and c-POCD group. Univariate analysis suggested that gender, smoking, drinking history, hypertension, white blood cell (WBC) count, aspartate aminotransferase (AST), high-sensitivity troponin (hs-CRP), arrhythmia, left atrial diameter (LAD), cardiopulmonary bypass (CPB) time, and the ascending aortic block (AAB) time were correlated with postoperative cognitive dysfunction after cardiac surgery. Multivariate regression analysis indicated that CPB time (P = 0.0015, OR (95% CI) = 6.696 (2.068-21.675), hypertension (P = 0.0098, OR (95%CI) = 3.776 (1.377-10.356), WBC count (P = 0.0227, OR (95%CI ) = 3.358 (1.184-9.522), AST (P = 0.0128, OR (95%CI) = 3.966 (1.340-11.735), and arrhythmia (P = 0.0017, OR (95%CI) = 5.164 (1.855-14.371) were the independent risk factors of cognitive dysfunction after cardiac surgery and used to establish a nomogram for clinical use. The initial C-index of the nomogram was 0.8182 and good calibration. Corrected C-index value of 0.793 was reached after internal validation. The area under ROC curve of this model was 0.8188 (95%CI: 0.7185-0.9190). The positive odds ratio (PLR) was 1.21 (95%CI: 1.1-1.3), and the negative odds ratio (NLR) was 0.18 (95%CI: 0.03-1.3).
This nomogram incorporating the CPB time, hypertension, WBC count, AST, and arrhythmia to predict the risk of c-POCD. The internal validation shows a good forecasting effect.
心脏手术后认知功能障碍（c-POCD）是一种常见的并发症。本文通过分析术前和术中数据建立了一个列线图，以帮助识别高危患者，并在早期采取有效管理预防 c-POCD。
本研究共纳入 265 例患者，其中 27 例被诊断为心脏手术后认知功能障碍（c-POCD）。患者分为对照组和 c-POCD 组。单因素分析表明，性别、吸烟、饮酒史、高血压、白细胞计数（WBC）、天门冬氨酸氨基转移酶（AST）、高敏肌钙蛋白（hs-CRP）、心律失常、左心房直径（LAD）、体外循环（CPB）时间和升主动脉阻断（AAB）时间与心脏手术后认知功能障碍相关。多因素回归分析表明，CPB 时间（P = 0.0015，OR（95%CI）=6.696（2.068-21.675））、高血压（P = 0.0098，OR（95%CI）=3.776（1.377-10.356））、白细胞计数（P = 0.0227，OR（95%CI）=3.358（1.184-9.522））、AST（P = 0.0128，OR（95%CI）=3.966（1.340-11.735））和心律失常（P = 0.0017，OR（95%CI）=5.164（1.855-14.371））是心脏手术后认知功能障碍的独立危险因素，并用于建立临床使用的列线图。该列线图的初始 C 指数为 0.8182，校准良好。内部验证后校正 C 指数值达到 0.793。该模型的 ROC 曲线下面积为 0.8188（95%CI：0.7185-0.9190）。阳性比值比（PLR）为 1.21（95%CI：1.1-1.3），阴性比值比（NLR）为 0.18（95%CI：0.03-1.3）。
本列线图纳入 CPB 时间、高血压、白细胞计数、AST 和心律失常来预测 c-POCD 的风险。内部验证显示出良好的预测效果。
