Wang Wei, Yao Wei, Tang Wanyun, Li Yuhao, Lv Qiaomei, Ding Wenbo
Department of Orthopedics, Dandong Central Hospital, China Medical University, Dandong, China.
Department of Oncology, Dandong Central Hospital, China Medical University, Dandong, China.
Front Med (Lausanne). 2024 Feb 14;11:1344904. doi: 10.3389/fmed.2024.1344904. eCollection 2024.
This study aims to examine the association between preoperative serum albumin levels and postoperative delirium (POD) in geriatric patients who have undergone hip fracture surgery, with the goal of offering novel insights for clinical interventions targeting POD.
A retrospective analysis was conducted on the medical records of patients who underwent hip fracture surgery in a tertiary medical institution from January 2013 to November 2023. The patients were classified based on hypoalbuminemia (defined as a serum albumin level < 35 g/L) and clinical threshold. Multivariable logistic regression and propensity score matching analysis (PSM) were employed to calculate the adjusted odds ratios (OR) and 95% confidence intervals (95% CI) for POD to eliminate potential confounding factors. Additionally, subgroup analysis was performed to explore the interaction effect.
The retrospective cohort study included 1,440 patients, with an incidence of POD found to be 19.1%. In a multivariable logistic regression analysis, patients with hypoalbuminemia had an adjusted OR of 2.99 (95%CI: 2.14-4.18) compared to those with normal albumin levels (≥ 35 g/L). Furthermore, a significant trend was observed across different severity categories, including mild hypoalbuminemia (34.9-30.0 g/L; adjusted OR = 2.71, 95%CI: 1.84-3.99), moderate hypoalbuminemia (29.9-25.0 g/L, adjusted OR = 3.44, 95%CI: 1.88-6.28), and severe hypoalbuminemia (<25.0 g/L; adjusted OR = 3.97, 95%CI: 1.78-8.86), with a trend value of <0.001. Similar results were observed in the PSM analysis. Additionally, treating preoperative serum albumin level as a continuous variable, the risk of POD increased by 11% (95% CI, 1.08-1.15) with each 1 g/L decrease in preoperative serum albumin level.
Low preoperative levels of albumin are strongly associated with POD in geriatric patients with hip fractures, and a significant dose-response relationship exists between them.
本研究旨在探讨老年髋部骨折手术患者术前血清白蛋白水平与术后谵妄（POD）之间的关联，以期为针对POD的临床干预提供新的见解。
对2013年1月至2023年11月在某三级医疗机构接受髋部骨折手术的患者病历进行回顾性分析。根据低白蛋白血症（定义为血清白蛋白水平<35 g/L）和临床阈值对患者进行分类。采用多变量逻辑回归和倾向得分匹配分析（PSM）计算POD的调整优势比（OR）和95%置信区间（95%CI），以消除潜在的混杂因素。此外，进行亚组分析以探索交互作用。
回顾性队列研究纳入1440例患者，POD发生率为19.1%。在多变量逻辑回归分析中，低白蛋白血症患者的调整OR为2.99（95%CI：2.14 - 4.18），而白蛋白水平正常（≥35 g/L）的患者为对照。此外，在不同严重程度类别中观察到显著趋势，包括轻度低白蛋白血症（34.9 - 30.0 g/L；调整OR = 2.71，95%CI：1.84 - 3.99）、中度低白蛋白血症（29.9 - 25.0 g/L，调整OR = 3.44，95%CI：1.88 - 6.28）和重度低白蛋白血症（<25.0 g/L；调整OR = 3.97，95%CI：1.78 - 8.86），趋势值<0.001。PSM分析中观察到类似结果。此外，将术前血清白蛋白水平视为连续变量，术前血清白蛋白水平每降低1 g/L，POD风险增加11%（95%CI，1.08 - 1.15）。
老年髋部骨折患者术前白蛋白水平低与POD密切相关，且二者之间存在显著的剂量反应关系。
