Shan Liang, Zheng Keyang, Dai Wenlong, Wang Yintang, Hao Peng
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Department of General Practice, Beijing Nuclear Industry Hospital, Beijing, China.
Front Med (Lausanne). 2025 Apr 1;12:1515940. doi: 10.3389/fmed.2025.1515940. eCollection 2025.
Postoperative delirium (POD) is a common complication following cardiac surgery that significantly affects patient outcomes. Among inflammatory markers, the monocyte-to-lymphocyte ratio (MLR) has shown potential in predicting POD. However, studies on the relationship between neutrophil-to-lymphocyte ratio (NLR) or platelet-to-lymphocyte ratio (PLR) and POD are still lacking. Moreover, a direct comparison of the predictive capabilities of these three inflammatory markers (NLR, MLR, and PLR) for POD remains unexplored.
This observational study utilized the MIMIC database. We included 2,095 patients who underwent cardiac surgery. Multivariable logistic regression analysis, restricted cubic spline (RCS) analysis, and receiver operating characteristic (ROC) curve analysis were employed to assess the relationship between NLR, MLR, PLR, and POD.
POD occurred in 415 patients (19.8%). Multivariable logistic regression identified NLR (OR 1.05, 95% CI 1.03-1.08), MLR (OR 1.39, 95% CI 1.01-1.92), and PLR (OR 1.00, 95% CI 1.00-1.00) as independent risk factors for POD, all with values < 0.05. ROC curve analysis revealed NLR had the strongest predictive ability (AUC = 0.610, 95% CI: 0.589-0.631), outperforming MLR (AUC = 0.575, 95% CI: 0.553-0.596) and PLR (AUC = 0.553, 95% CI: 0.531-0.574). RCS analysis indicated linear or near-linear relationships between these markers and POD risk.
NLR, MLR, and PLR independently predicted postoperative delirium following cardiac surgery, with NLR demonstrating the strongest predictive capacity. These findings provided new tools for preoperative risk assessment and may improve postoperative management strategies for cardiac surgery patients.
术后谵妄（POD）是心脏手术后常见的并发症，会显著影响患者的预后。在炎症标志物中，单核细胞与淋巴细胞比值（MLR）在预测POD方面已显示出潜力。然而，关于中性粒细胞与淋巴细胞比值（NLR）或血小板与淋巴细胞比值（PLR）与POD之间关系的研究仍然缺乏。此外，这三种炎症标志物（NLR、MLR和PLR）对POD预测能力的直接比较仍未得到探索。
这项观察性研究使用了MIMIC数据库。我们纳入了2095例接受心脏手术的患者。采用多变量逻辑回归分析、限制性立方样条（RCS）分析和受试者工作特征（ROC）曲线分析来评估NLR、MLR、PLR与POD之间的关系。
415例患者（19.8%）发生了POD。多变量逻辑回归确定NLR（比值比1.05，95%置信区间1.03 - 1.08）、MLR（比值比1.39，95%置信区间1.01 - 1.92）和PLR（比值比1.00，95%置信区间1.00 - 1.00）为POD的独立危险因素，所有P值均<0.05。ROC曲线分析显示NLR具有最强的预测能力（曲线下面积[AUC]=0.610，95%置信区间：0.589 - 0.631），优于MLR（AUC = 0.575，95%置信区间：0.553 - 0.596）和PLR（AUC = 0.553，95%置信区间：0.531 - 0.574）。RCS分析表明这些标志物与POD风险之间存在线性或近似线性关系。
NLR、MLR和PLR可独立预测心脏手术后的术后谵妄，其中NLR的预测能力最强。这些发现为术前风险评估提供了新工具，并可能改善心脏手术患者的术后管理策略。
