术前预后营养指数作为预测老年退行性腰椎疾病患者术后谵妄的有用工具
Preoperative Prognostic Nutritional Index as a Useful Tool for Predicting Postoperative Delirium in Elderly Patients with Degenerative Lumbar Diseases.
作者信息
Zhou Jinlei, Tang Jing, Xie Shanggao, Shao Haiyu, Xia Chen, Huang Yazeng, Zhao Tingxiao
机构信息
Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, People's Republic of China.
Zhejiang Rehabilitation Medical Center, Department of Orthopedics, Hangzhou, Zhejiang, People's Republic of China.
出版信息
Ther Clin Risk Manag. 2025 Jun 7;21:851-859. doi: 10.2147/TCRM.S520912. eCollection 2025.
PURPOSE
The high incidence of postoperative delirium (POD) among patients undergoing lumbar spine surgery presents a significant barrier to achieving enhanced postoperative recovery. Accordingly, a thorough understanding and precise identification of common risk factors for POD in this surgical context are crucial to mitigating its occurrence and facilitating improved recovery outcomes. This study is the first to assess the predictive value of the Prognostic Nutritional Index (PNI) for POD in elderly patients undergoing transforaminal lumbar interbody fusion (TLIF) for degenerative lumbar spine disease.
METHODS
We conducted a retrospective analysis of the outcomes of TLIF surgery in elderly patients with degenerative lumbar spine disease between 2020 and 2024. The diagnosis of POD was based on postoperative medical records during hospitalization, using the Confusion Assessment Method. The PNI was calculated based on preoperative serum albumin levels and total lymphocyte counts. Multivariate logistic regression analysis was performed to evaluate the relationship between preoperative PNI scores and the occurrence of POD. Finally, the optimal PNI cut-off point for predicting POD was determined using the receiver operating characteristic curve.
RESULTS
POD was observed in 61 of 370 patients, with PNI being significantly lower in the delirium group. The mean PNI values were 43.02±3.44 in the non-delirium group and 48.53±3.72 in the delirium group. Multivariate logistic regression analysis revealed that low PNI (OR: 0.743; 95% CI: 0.597-0.924; p = 0.008), low serum albumin levels (OR: 0.759; 95% CI: 0.584-0.987; p = 0.040), and advanced age (OR: 1.096; 95% CI: 1.030-1.166; p = 0.004) were independent predictors of POD following TLIF. The area under the curve (AUC) for PNI on the receiver operating characteristic curve was 0.864±0.025. The cutoff value for PNI, determined using the Youden index, was 45.825, with a sensitivity of 82.0% and a specificity of 74.4%.
CONCLUSION
The preoperative use of PNI holds promise as a valuable tool for assessing the risk of POD in elderly patients undergoing TLIF.
目的
腰椎手术患者术后谵妄（POD）的高发生率是实现术后加速康复的重大障碍。因此，在这种手术背景下，全面了解并准确识别POD的常见风险因素对于减少其发生并促进改善康复结果至关重要。本研究首次评估了预后营养指数（PNI）对接受经椎间孔腰椎椎间融合术（TLIF）治疗退行性腰椎疾病的老年患者发生POD的预测价值。
方法
我们对2020年至2024年间接受TLIF手术治疗退行性腰椎疾病的老年患者的手术结果进行了回顾性分析。POD的诊断基于住院期间的术后病历，采用谵妄评估方法。PNI根据术前血清白蛋白水平和总淋巴细胞计数计算得出。进行多因素逻辑回归分析以评估术前PNI评分与POD发生之间的关系。最后，使用受试者工作特征曲线确定预测POD的最佳PNI截断点。
结果
370例患者中有61例发生POD，谵妄组的PNI显著较低。非谵妄组的平均PNI值为43.02±3.44，谵妄组为48.53±3.72。多因素逻辑回归分析显示，低PNI（OR：0.743；95%CI：0.597 - 0.924；p = 0.008）、低血清白蛋白水平（OR：0.759；95%CI：0.584 - 0.987；p = 0.040）和高龄（OR：1.096；95%CI：1.030 - 1.166；p = 0.004）是TLIF术后POD的独立预测因素。受试者工作特征曲线上PNI的曲线下面积（AUC）为0.864±0.025。使用约登指数确定的PNI截断值为45.825，灵敏度为82.0%，特异度为74.4%。
结论
术前使用PNI有望成为评估接受TLIF的老年患者发生POD风险的有价值工具。
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