Wang Cunjin, Song Xiaowei, Cao Lan, Guo Fang, Gao Ju
Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, 225001, China.
Department of Anesthesiology, Northern Jiangsu People's Hospital, Yangzhou, 225001, China.
BMC Gastroenterol. 2025 Mar 24;25(1):198. doi: 10.1186/s12876-025-03782-6.
Postoperative delirium (POD) is generally associated with increased postoperative adverse events. We aimed to investigate whether preoperative quantitative quadriceps muscle ultrasound could predict POD in older patients after gastrointestinal surgery in order to provide more targeted prevention and treatment measures.
We prospectively collected data from elderly patients who underwent elective gastrointestinal surgery from August to December 2023 at a tertiary hospital in China. Intergroup difference analysis and univariate and multivariate logistic regression analyses were used to explore independent risk factors. We calculated and assessed the parameters via sensitivity, specificity, the Youden index, and the area under the receiver operating characteristic curve (AUC), calibration curves and the Hosmer-Lemeshow test. The nomogram was validated internally through bootstrap resampling. The decision curve analysis (DCA) was used to evaluate its clinical validity.
A total of 695 patients who underwent gastrointestinal surgery were analyzed in this investigation, among which 137 patients experienced POD with an incidence rate of 19.7%. After conducting multivariate logistic regression analyses using R software, six independent risk factors associated with POD were identified, including age, quadriceps muscle thickness (Q-MT), quadriceps echo intensity (Q-EI), Charlson Comorbidity Index (CCI), preoperative frailty and preoperative Minimum Mental State Examination (MMSE) scores. The AUC value of the model was 0.966 (95% CI: 0.950-0.982; p < 0.05). The calibration curve revealed that the predicted probability of the nomogram was consistent with the actual probability, and the Hosmer-Lemeshow goodness-of-fit test value was 0.811. DCA revealed that the nomogram has a net benefit for POD.
Quantitative quadriceps ultrasound parameters, including the Q-MT and Q-EI, could predict POD after gastrointestinal surgery in older patients. We have developed a new nomogram for predicting POD in older patients who undergo gastrointestinal surgery.
The trial was registered in the Chinese Clinical Trial Registry ( http://www.chictr.org.cn/ ) on August 3, 2023, with the registration number of ChiCTR2300074304.
术后谵妄（POD）通常与术后不良事件增加相关。我们旨在研究术前股四头肌定量超声检查能否预测老年患者胃肠道手术后的POD，以便提供更有针对性的防治措施。
我们前瞻性收集了2023年8月至12月在中国一家三级医院接受择期胃肠道手术的老年患者的数据。采用组间差异分析、单因素和多因素逻辑回归分析来探索独立危险因素。我们通过敏感性、特异性、约登指数、受试者工作特征曲线下面积（AUC）、校准曲线和Hosmer-Lemeshow检验来计算和评估参数。通过自助重采样对列线图进行内部验证。采用决策曲线分析（DCA）评估其临床有效性。
本研究共分析了695例接受胃肠道手术的患者，其中137例发生POD，发生率为19.7%。使用R软件进行多因素逻辑回归分析后，确定了6个与POD相关的独立危险因素，包括年龄、股四头肌厚度（Q-MT）、股四头肌回声强度（Q-EI）、Charlson合并症指数（CCI）、术前衰弱和术前简易精神状态检查表（MMSE）评分。该模型的AUC值为0.966（95%CI：0.950-0.982；p<0.05）。校准曲线显示列线图的预测概率与实际概率一致，Hosmer-Lemeshow拟合优度检验值为0.811。DCA显示列线图对POD有净效益。
包括Q-MT和Q-EI在内的股四头肌超声定量参数可预测老年患者胃肠道手术后的POD。我们开发了一种新的列线图，用于预测接受胃肠道手术的老年患者的POD。
该试验于2023年8月3日在中国临床试验注册中心（http://www.chictr.org.cn/）注册，注册号为ChiCTR2300074304。
