Department of Anesthesiology, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), 5, Dong-Hai Middle Road, Shi-Nan District, 266000, Qingdao, China.
Department of Anesthesiology, Qingdao Eighth People's Hospital, Qingdao, China.
BMC Anesthesiol. 2023 Jun 23;23(1):222. doi: 10.1186/s12871-023-02178-x.
This study aimed to reveal the relationship between alcohol consumption and Postoperative delirium (POD) in the elderly.
We selected 252 patients from the Perioperative Neurocognitive Disorder And Biomarker Lifestyle (PNDABLE ) study. Patients in the PNDABLE database have been measured for Alzheimer-related biomarkers in CSF (Aβ, Aβ, P-tau, and tau protein). Mini-Mental State Examination (MMSE) was used to assess the preoperative mental status of patients. POD was diagnosed using the Confusion Assessment Method (CAM) and assessed for severity using the Memorial Delirium Assessment Scale (MDAS). Logistic regression analysis was utilized to explore the association of alcohol consumption with POD. Linear regression analysis was used to study the relationship between alcohol consumption and CSF biomarkers. Mediation analyses with 10,000 bootstrapped iterations were used to explore the mediation effects. Finally, we constructed the receiver operating characteristic (ROC) curve and the nomogram model to evaluate the efficacy of alcohol consumption and CSF biomarkers in predicting POD. RESULT: The incidence of POD was 17.5%. Logistic regression showed that alcohol consumption (OR = 1.016, 95%CI 1.009-1.024, P < 0.001) is a risk factor for POD. What's more, Aβ is a protective factor for POD (OR = 0.993, 95%CI 0.989-0.997, P < 0.05), and P-Tau was a risk factor for POD (OR = 1.093, 95%CI 1.022-1.168, P < 0.05). Linear regression analysis revealed that alcohol consumption was negatively associated with CSF Aβ (β = -0.638, P < 0.001) in POD patients. Mediation analyses showed that alcohol consumption is likely to partially mediate POD through Aβ42 (proportion:14.21%). ROC curve showed that alcohol consumption (AUC = 0.904; P < 0.001) exhibited a relatively better discriminatory ability in POD prediction compared to Aβ (AUC = 0.798; P < 0.001). The calibration curve indicated a good nomogram prediction (P = 0.797).
Alcohol consumption is a risk factor for POD (particularly for those with > 24 g a day on average) in the elderly, and contributes to POD through the mediation of Aβ.
本研究旨在揭示老年人饮酒与术后谵妄（POD）之间的关系。
我们从围手术期神经认知障碍和生物标志物生活方式（PNDABLE）研究中选择了 252 名患者。PNDABLE 数据库中的患者已经测量了与阿尔茨海默病相关的脑脊液生物标志物（Aβ、Aβ42、P-tau 和 tau 蛋白）。使用简易精神状态检查（MMSE）评估患者术前的精神状态。使用意识模糊评估法（CAM）诊断 POD，并使用记忆谵妄评估量表（MDAS）评估其严重程度。采用逻辑回归分析探讨饮酒与 POD 的关系。采用线性回归分析研究饮酒与脑脊液生物标志物的关系。采用 10000 次 bootstrap 迭代的中介分析探讨中介效应。最后，我们构建了受试者工作特征（ROC）曲线和列线图模型，以评估饮酒和脑脊液生物标志物预测 POD 的疗效。
POD 的发生率为 17.5%。逻辑回归显示，饮酒（OR=1.016，95%CI 1.009-1.024，P<0.001）是 POD 的危险因素。此外，Aβ是 POD 的保护因素（OR=0.993，95%CI 0.989-0.997，P<0.05），而 P-Tau 是 POD 的危险因素（OR=1.093，95%CI 1.022-1.168，P<0.05）。线性回归分析显示，饮酒与 POD 患者的 CSF Aβ 呈负相关（β=-0.638，P<0.001）。中介分析表明，饮酒可能通过 Aβ42 部分介导 POD（比例：14.21%）。ROC 曲线显示，与 Aβ（AUC=0.798；P<0.001）相比，饮酒（AUC=0.904；P<0.001）在 POD 预测中具有更好的区分能力。校准曲线表明列线图预测效果较好（P=0.797）。
饮酒是老年人 POD（特别是每天饮酒>24g 的老年人）的危险因素，通过 Aβ 介导导致 POD。
