Zhang Jingya, Basnet Diksha, Du Xue, Yang Junjun, Liu Jiehui, Wu Fan, Zhang Xiaoqing, Liu Jianhui
Department of Anesthesiology, School of Medicine, Tongji Hospital, Tongji University, Shanghai, China.
Front Aging Neurosci. 2022 Nov 15;14:995781. doi: 10.3389/fnagi.2022.995781. eCollection 2022.
Delayed neurocognitive recovery (DNR) is a common post-surgical complication among the elderly. Cognitive frailty (CF) is also an age-related medical syndrome. However, little is known about the association between CF and DNR. Therefore, this study aimed to study whether CF is associated with DNR in elderly patients undergoing elective noncardiac surgery, as well as to explore the potential risk factors for DNR in frail elderly individuals and construct a prediction model.
This prospective cohort study administered a battery of cognitive and frailty screening instruments for 146 individuals (≥65 years old) scheduled for elective noncardiac surgery. Screening for CF was performed at least one day before surgery, and tests for the presence of DNR were performed seven days after surgery. The association between CF and DNR was investigated. Moreover, the study subjects were randomly divided into a modeling group (70%) and a validation group (30%). Univariate and multivariate logistic regression was performed to analyze the modeling group data and identify the independent risk factors for DNR. The R software was used to construct DNR's nomogram model, verifying the model.
In total, 138 individuals were eligible. Thirty-three cases were diagnosed with DNR (23.9%). No significant difference in the number of patients with CF was observed between the DNR and non-DNR groups ( > 0.05). Multivariate analysis after adjusting relevant risk factors showed that only the judgment of line orientation (JLOT) test score significantly affected the incidence of DNR. After internal validation of the constructed DNR prediction model, the area under the curve (AUC) of the forecast probability for the modeling population ( = 97) for DNR was 0.801, and the AUC for the validation set ( = 41) was 0.797. The calibration curves of both the modeling and validation groups indicate that the prediction model has good stability.
Cognitive frailty is not an independent risk factor in predicting DNR after noncardiac surgery in frail elderly individuals. The preoperative JLOT score is an independent risk factor for DNR in frail elderly individuals. The prediction model has a good degree of discrimination and calibration, which means that it can individually predict the risk probability of DNR in frail elderly individuals.
延迟神经认知恢复（DNR）是老年人常见的术后并发症。认知衰弱（CF）也是一种与年龄相关的医学综合征。然而，关于CF与DNR之间的关联知之甚少。因此，本研究旨在探讨老年择期非心脏手术患者中CF是否与DNR相关，以及探索衰弱老年个体中DNR的潜在危险因素并构建预测模型。
这项前瞻性队列研究对146例计划进行择期非心脏手术的个体（≥65岁）使用了一系列认知和衰弱筛查工具。在手术前至少一天进行CF筛查，并在术后七天进行DNR检测。研究CF与DNR之间的关联。此外，研究对象被随机分为建模组（70%）和验证组（30%）。对建模组数据进行单因素和多因素逻辑回归分析，以确定DNR的独立危险因素。使用R软件构建DNR的列线图模型并对模型进行验证。
共有138例个体符合条件。33例被诊断为DNR（23.9%）。DNR组和非DNR组之间CF患者数量无显著差异（>0.05）。调整相关危险因素后的多因素分析表明，只有线方向判断（JLOT）测试分数显著影响DNR的发生率。对构建的DNR预测模型进行内部验证后，建模人群（n = 97）DNR预测概率的曲线下面积（AUC）为0.801，验证集（n = 41）的AUC为0.797。建模组和验证组的校准曲线均表明预测模型具有良好的稳定性。
认知衰弱不是预测衰弱老年个体非心脏手术后DNR的独立危险因素。术前JLOT分数是衰弱老年个体DNR的独立危险因素。该预测模型具有良好的区分度和校准度，这意味着它可以单独预测衰弱老年个体中DNR的风险概率。
