Yu Rili, Yang Mi, Chen Juan, Zhang Fan
Department of Anesthesiology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.
Department of Endocrinology, The First Hospital of Changsha, Changsha, Hunan, People's Republic of China.
PLoS One. 2025 Mar 27;20(3):e0320719. doi: 10.1371/journal.pone.0320719. eCollection 2025.
Postoperative delirium (POD) is one of the most common complications in geriatric patients following surgery. Physiological concentration of bilirubin possesses anti-inflammatory, antioxidant and neuroprotective effects, which are important protective mechanisms against POD. This study aimed to explore the relationship between preoperative serum bilirubin and POD in geriatric patients undergoing joint replacement.
Geriatric patients who underwent hip or knee joint replacement surgery under intrathecal anesthesia were included. These patients had American Society of Anesthesiologists (ASA) grades I to III. The patients with a history of psychiatric or neurological disorders, infectious diseases or sepsis, hemolytic anemia, liver diseases, performed general anesthesia or intrathecal anesthesia combined with general anesthesia, or insufficient surgical information were excluded. Patients' age, gender, weight, height, ASA classification, liver function and bilirubin within one week before surgery, preoperative Mini-Mental State Examination (MMSE) scores, surgical type, dosage of medications, intraoperative bleeding volume, postoperative average numeric rating scale (NRS) pain scores, the occurrence of POD and Delirium Rating Scale-Revised-98 (DRS-R-98) scores for POD were collected.
A total of 269 patients were eligible for inclusion in the study, with 23.05% (62/207) exhibiting POD. Patients with POD exhibited higher age and ASA classification, and had lower weight, serum total serum bilirubin (TBIL) and indirect bilirubin (IBIL) within one week before surgery, and preoperative MMSE scores (all p < 0.05). Univariate logistic regression analysis showed that the above variables were correlated with the occurrence of POD (all p < 0.05). Multivariate logistic regression analysis revealed that age was a risk factor (p < 0.001, OR = 1.14, 95% CI [1.07-1.21]), while weight (p = 0.041, OR = 0.96, 95% CI [0.92-0.99]), IBIL levels within one week before surgery (p = 0.012, OR = 0.65, 95% CI [0.47-0.91]) and preoperative MMSE scores (p < 0.001, OR = 0.84, 95% CI [0.78-0.91]) served as protective factors against the occurrence of POD. The serum IBIL concentration within one week before surgery was performed receiver operating characteristic (ROC) curve analysis. The estimated cutoff value for predicting the occurrence of POD was 6.65 μmol/L, and area under the curve (AUC) was 0.63. Patients with preoperative serum IBIL concentration below 6.65 μmol/L had a higher incidence of POD.
Patients with lower preoperative serum IBIL levels exhibited a higher incidence of POD in geriatric patients undergoing joint replacement. Low serum IBIL was a risk factor and a predictor for the occurrence of POD.
术后谵妄（POD）是老年患者术后最常见的并发症之一。生理浓度的胆红素具有抗炎、抗氧化和神经保护作用，是预防POD的重要保护机制。本研究旨在探讨老年关节置换患者术前血清胆红素与POD之间的关系。
纳入在鞘内麻醉下行髋或膝关节置换手术的老年患者。这些患者的美国麻醉医师协会（ASA）分级为I至III级。排除有精神或神经疾病史、传染病或脓毒症、溶血性贫血、肝脏疾病、接受全身麻醉或鞘内麻醉联合全身麻醉或手术信息不完整的患者。收集患者的年龄、性别、体重、身高、ASA分级、术前一周内的肝功能和胆红素、术前简易精神状态检查表（MMSE）评分、手术类型、用药剂量、术中出血量、术后平均数字评定量表（NRS）疼痛评分、POD的发生情况以及POD的谵妄评定量表修订版98（DRS-R-98）评分。
共有269例患者符合纳入本研究的条件，其中23.05%（62/270）出现POD。发生POD的患者年龄和ASA分级较高，术前一周内体重、血清总胆红素（TBIL）和间接胆红素（IBIL）较低，术前MMSE评分也较低（均p<0.05）。单因素logistic回归分析显示，上述变量与POD的发生相关（均p<0.05）。多因素logistic回归分析显示，年龄是一个危险因素（p<0.001，OR=1.14，95%CI[1.07-1.21]），而体重（p=0.041，OR=0.96，95%CI[0.92-0.99]）、术前一周内的IBIL水平（p=0.012，OR=0.65，95%CI[0.47-0.91]）和术前MMSE评分（p<0.001，OR=0.84，95%CI[0.78-0.91]）是预防POD发生的保护因素。对术前一周内的血清IBIL浓度进行受试者操作特征（ROC）曲线分析。预测POD发生的估计临界值为6.65μmol/L，曲线下面积（AUC）为0.63。术前血清IBIL浓度低于6.65μmol/L的患者POD发生率较高。
在接受关节置换的老年患者中，术前血清IBIL水平较低的患者POD发生率较高。低血清IBIL是POD发生的危险因素和预测指标。
