Wang Jun, Zhong Hui, Chen Lu, Ding Hong-Chun, Lu Zhong-Jie, Wang Bin-Su, Liu Shun-Bi, Luo Jing, Hou Li-Wen, Liu Yuan-Zhang, Ding Sheng, Gao Feng, Jiang Li
ICU, Department of Cardiovascular Surgery, People's Liberation Army The General Hospital of Western Theater Command, Chengdu, Sichuan, China.
Department of Cardiology, The Second Affiliated Hospital (Xinqiao Hospital) of Army Medical University, Chongqing, China.
Front Cardiovasc Med. 2025 May 19;12:1592161. doi: 10.3389/fcvm.2025.1592161. eCollection 2025.
Open heart surgery (OHS) is crucial for treating cardiovascular diseases, but postoperative delirium (POD) is a common and challenging complication. Existing POD prognostic indicators have limitations in clinical application. The relationship between AG and POD in OHS patients remains unclear.
Data from the MIMIC-IV database were used. Patients aged 18 or older who underwent OHS, were admitted to the ICU post-surgery, and had an AG test within the first 24 h after surgery were included. The maximum AG value within 24 h after surgery was the exposure variable, and POD occurrence was the primary outcome. Multivariable logistic regression was applied to explore the relationship between AG and POD. A restricted cubic spline regression model (RCSRM) was used to analyze the correlation shape, and subgroup and interaction analyses were performed. Causal mediation analysis (CMA) was conducted to explore the mediating role of ICU length of stay (LOS) in the relationship between AG and POD.
We included 6,429 patients. The overall POD incidence was 13%. Multivariable logistic regressions showed that AG was significantly associated with POD (OR = 1.686, 95% CI: 1.348-2.113, < 0.001 for group 2; OR = 1.54, 95% CI: 1.161-2.037, = 0.003 for group 3; OR = 2.005, 95% CI: 1.574-2.558, < 0.001 for group 4; for trend <0.001) and ICU LOS (OR = 1.256, 95% CI: 1.066-1.48, = 0.007 for group 2; OR = 1.281, 95% CI: 1.033-1.585, = 0.023 for group 3; OR = 1.595, 95% CI: 1.32-1.928, < 0.001 for group 4). The RCSRM revealed a non-linear relationship between AG and POD (-overall <0.001, for non-linear = 0.042). No multiplicative or additive interactions were detected between AG and any subgroup. CMA indicated that ICU LOS mediated 5.392% (95% CI: 0.483%-11.98%; = 0.034) of the effect of AG on POD.
An elevated AG level within the first 24 h after OHS is significantly associated with an increased risk of POD, and the relationship shows a tendency toward non-linearity. ICU LOS may proportionally mediate the impact of AG on POD development.
心脏直视手术（OHS）对于治疗心血管疾病至关重要，但术后谵妄（POD）是一种常见且具有挑战性的并发症。现有的POD预后指标在临床应用中存在局限性。OHS患者中AG与POD之间的关系仍不清楚。
使用MIMIC-IV数据库中的数据。纳入年龄在18岁及以上、接受OHS、术后入住重症监护病房（ICU）且在术后24小时内进行AG检测的患者。术后24小时内的最大AG值为暴露变量，POD的发生为主要结局。应用多变量逻辑回归来探讨AG与POD之间的关系。使用受限立方样条回归模型（RCSRM）分析相关形状，并进行亚组和交互分析。进行因果中介分析（CMA）以探讨ICU住院时间（LOS）在AG与POD关系中的中介作用。
我们纳入了6429例患者。总体POD发生率为13%。多变量逻辑回归显示，AG与POD显著相关（第2组：OR = 1.686，95% CI：1.348 - 2.113，P < 0.001；第3组：OR = 1.54，95% CI：1.161 - 2.037，P = 0.003；第4组：OR = 2.005，95% CI：1.574 - 2.558，P < 0.001；趋势P < 0.001）以及与ICU LOS相关（第2组：OR = 1.256，95% CI：1.066 - 1.48，P = 0.007；第3组：OR = 1.281，95% CI：1.033 - 1.585，P = 0.023；第4组：OR = 1.595，95% CI：1.32 - 1.928，P < 0.001）。RCSRM显示AG与POD之间存在非线性关系（总体P < 0.001，非线性P = 0.042）。未检测到AG与任何亚组之间的乘性或加性交互作用。CMA表明，ICU LOS介导了AG对POD影响的5.392%（95% CI：0.483% - 11.98%；P = 0.034）。
OHS后24小时内AG水平升高与POD风险增加显著相关，且这种关系呈非线性趋势。ICU LOS可能按比例介导AG对POD发生发展的影响。
