Li Guan-Hua, Zhao Ling, Lu Yan, Wang Wei, Ma Tao, Zhang Ying-Xin, Zhang Hao
Department of Anesthesiology, Characteristic Medical Center of the PLA Rocket Force, Beijing 100088, China.
Department of Neurology, Characteristic Medical Center of the PLA Rocket Force, Beijing 100088, China.
J Clin Anesth. 2021 Dec;75:110408. doi: 10.1016/j.jclinane.2021.110408. Epub 2021 Jul 6.
To develop and validate a simple delirium-predicting scoring system in patients undergoing major abdominal surgery by incorporating preoperative risk factors and intraoperative surgical Apgar score (SAS).
Observational retrospective cohort study.
A tertiary general hospital in China.
1055 patients who received major abdominal surgery from January 2015 to December 2019.
We collected data on preoperative and intraoperative variables, and postoperative delirium. A risk scoring system for postoperative delirium in patients after major open abdominal surgery was developed and validated based on traditional logistic regression model. The elastic net algorithm was further developed and evaluated.
The incidence of postoperative delirium was 17.8% (188/1055) in these patients. They were randomly divided into the development (n = 713) and validation (n = 342) cohorts. Both the logistic regression model and the elastic net regression model identified that advanced age, arrythmia, hypoalbuminemia, coagulation dysfunction, mental illness or cognitive impairments and low surgical Apgar score are related with increased risk of postoperative delirium. The elastic net algorithm has an area under the receiver operating characteristic curve (AUROC) of 0.842 and 0.822 in the development and validation cohorts, respectively. A prognostic score was calculated using the following formula: Prognostic score = Age classification (0 to 3 points) + arrythmia + 2 * hypoalbuminemia + 2 * coagulation dysfunction + 4 * mental illness or cognitive impairments + (10-surgical Apgar score). The 22-point risk scoring system had good discrimination and calibration with an AUROC of 0.823 and 0.834, and a non-significant Hosmer-Lemeshow test P = 0.317 and P = 0.853 in the development and validation cohorts, respectively. The bootstrapping internal verification method (R = 1000) yielded a C-index of 0.822 (95% CI: 0.759-0.857).
The prognostic scoring system, which used both preoperative risk factors and surgical Apgar score, serves as a good first step toward a clinically useful predictive model for postoperative delirium in patients undergoing major open abdominal surgery.
通过纳入术前风险因素和术中手术阿普加评分（SAS），开发并验证一种用于接受腹部大手术患者的简单谵妄预测评分系统。
观察性回顾性队列研究。
中国一家三级综合医院。
2015年1月至2019年12月期间接受腹部大手术的1055例患者。
我们收集了术前和术中变量以及术后谵妄的数据。基于传统逻辑回归模型，开发并验证了一种用于腹部大手术后患者术后谵妄的风险评分系统。进一步开发并评估了弹性网算法。
这些患者术后谵妄的发生率为17.8%（188/1055）。他们被随机分为开发队列（n = 713）和验证队列（n = 342）。逻辑回归模型和弹性网回归模型均确定高龄、心律失常、低白蛋白血症、凝血功能障碍、精神疾病或认知障碍以及低手术阿普加评分与术后谵妄风险增加相关。弹性网算法在开发队列和验证队列中的受试者操作特征曲线下面积（AUROC）分别为0.842和0.822。使用以下公式计算预后评分：预后评分 = 年龄分类（0至3分）+ 心律失常 + 2×低白蛋白血症 + 2×凝血功能障碍 + 4×精神疾病或认知障碍 +（10 - 手术阿普加评分）。22分的风险评分系统具有良好的区分度和校准度，在开发队列和验证队列中的AUROC分别为0.823和0.834，Hosmer - Lemeshow检验P值分别为0.317和0.853，差异无统计学意义。自举内部验证方法（R = 1000）得出的C指数为0.822（95%CI：0.759 - 0.857）。
该预后评分系统同时使用术前风险因素和手术阿普加评分，是朝着为接受腹部大手术患者建立临床有用的术后谵妄预测模型迈出的良好第一步。
