Development of an early prediction model for postoperative delirium in neurosurgical patients admitted to the ICU after elective craniotomy (E-PREPOD-NS): A secondary analysis of a prospective cohort study

被引:7
作者
Huang, Hua-Wei [1 ]
Zhang, Guo-Bin [2 ]
Li, Hao-Yi [2 ]
Wang, Chun-Mei [1 ]
Wang, Yu-Mei [1 ]
Sun, Xiu-Mei [1 ]
Chen, Jing-Ran [1 ]
Chen, Guang-Qiang [1 ]
Xu, Ming [1 ]
Zhou, Jian-Xin [1 ]
机构
[1] Capital Med Univ, Beijing Tiantan Hosp, Dept Crit Care Med, South 4th Ring West Rd 119, Beijing 100070, Peoples R China
[2] Capital Med Univ, Beijing Tiantan Hosp, Dept Neurosurg, Beijing, Peoples R China
基金
中国国家自然科学基金;
关键词
Postoperative delirium; Neurosurgical patients; Intracranial surgery; Risk prediction model; Intensive care unit; INTENSIVE-CARE-UNIT; RISK-FACTORS; SURGERY; COMPLICATIONS; ATTENTION; SCALE; OLDER;
D O I
10.1016/j.jocn.2021.06.004
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Postoperative delirium (POD) is a significant clinical problem in neurosurgical patients after intracranial surgery. Identification of high-risk patients may optimize perioperative management, but an adequate risk model for use at early phase after operation has not been developed. In the secondary analysis of a prospective cohort study, 800 adult patients admitted to the ICU after elective intracranial surgeries were included. The POD was diagnosed as Confusion Assessment Method for the ICU positive on postop-erative day 1 to 3. Multivariate logistic regression analysis was used to develop early prediction model (E-PREPOD-NS) and the final model was validated with 200 bootstrap samples. The incidence of POD in this cohort was19.6%. We identified nine variables independently associated with POD in the final model: advanced age (OR 3.336, CI 1.765-6.305, 1 point), low education level (OR 2.528, 1.446-4.419, 1), smok-ing history (OR 2.582, 1.611-4.140, 1), diabetes (OR 2.541, 1.201-5.377, 1), supra-tentorial lesions (OR 3.424, 2.021-5.802, 1), anesthesia duration > 360 min (OR 1.686, 1.062-2.674, 0.5), GCS < 9 at ICU admis-sion (OR 6.059, 3.789-9.690, 1.5), metabolic acidosis (OR 13.903, 6.248-30.938, 2.5), and neurosurgical drainage tube (OR 1.924, 1.132-3.269, 0.5). The area under the receiver operator curve (AUROC) of the risk score for prediction of POD was 0.865 (95% CI 0.835-0.895). The AUROC was 0.851 after internal val-idation (95% CI 0.791-0.912). The model showed good calibration. The E-PREPOD-NS model can predict POD in patients admitted to the ICU after elective intracranial surgery with good accuracy. External val-idation is needed in the future. (c) 2021 Published by Elsevier Ltd.
引用
收藏
页码:217 / 224
页数:8
相关论文
共 38 条
  • [1] Outcome and quality of life in patients with postoperative delirium during an ICU stay following major surgery
    Abelha, Fernando J.
    Luis, Clara
    Veiga, Dalila
    Parente, Daniela
    Fernandes, Vera
    Santos, Patricia
    Botelho, Miguela
    Santos, Alice
    Santos, Cristina
    [J]. CRITICAL CARE, 2013, 17 (05):
  • [2] European Society of Anaesthesiology evidence-based and consensus-based guideline on postoperative delirium
    Aldecoa, Cesar
    Bettelli, Gabriella
    Bilotta, Federico
    Sanders, Robert D.
    Audisio, Riccardo
    Borozdina, Anastasia
    Cherubini, Antonio
    Jones, Christina
    Kehlet, Henrik
    MacLullich, Alasdair
    Radtke, Finn
    Riese, Florian
    Slooter, Arjen J. C.
    Veyckemans, Francis
    Kramer, Sylvia
    Neuner, Bruno
    Weiss, Bjoern
    Spies, Claudia D.
    [J]. EUROPEAN JOURNAL OF ANAESTHESIOLOGY, 2017, 34 (04) : 192 - 214
  • [3] Postoperative Delirium as a Target for Surgical Quality Improvement
    Berian, Julia R.
    Zhou, Lynn
    Russell, Marcia M.
    Homor, Melissa A.
    Cohen, Mark E.
    Finlayson, Emily
    Ko, Clifford Y.
    Rosenthal, Ronnie A.
    Robinson, Thomas N.
    [J]. ANNALS OF SURGERY, 2018, 268 (01) : 93 - 99
  • [4] Predicting delirium after vascular surgery -: A model based on pre- and intraoperative data
    Böhner, H
    Hummel, TC
    Habel, U
    Miller, C
    Reinbott, S
    Yang, Q
    Gabriel, A
    Friedrichs, R
    Müller, EE
    Ohmann, C
    Sandmann, W
    Schneider, F
    [J]. ANNALS OF SURGERY, 2003, 238 (01) : 149 - 156
  • [5] Control of goal-directed and stimulus-driven attention in the brain
    Corbetta, M
    Shulman, GL
    [J]. NATURE REVIEWS NEUROSCIENCE, 2002, 3 (03) : 201 - 215
  • [6] Risk factors for postoperative delirium in patients undergoing lower extremity joint arthroplasty: a retrospective population-based cohort study
    Cozowicz, Crispiana
    Memtsoudis, Stavros G.
    Poeran, Jashvant
    [J]. REGIONAL ANESTHESIA AND PAIN MEDICINE, 2021, 46 (01) : 94 - +
  • [7] Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit
    Ely, EW
    Shintani, A
    Truman, B
    Speroff, T
    Gordon, SM
    Harrell, FE
    Inouye, SK
    Bernard, GR
    Dittus, RS
    [J]. JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2004, 291 (14): : 1753 - 1762
  • [8] Recommendations for the nomenclature of cognitive change associated with anaesthesia and surgery-2018
    Evered, L.
    Silbert, B.
    Knopman, D. S.
    Scott, D. A.
    DeKosky, S. T.
    Rasmussen, L. S.
    Oh, E. S.
    Crosby, G.
    Berger, M.
    Eckenhoff, R. G.
    [J]. BRITISH JOURNAL OF ANAESTHESIA, 2018, 121 (05) : 1005 - 1012
  • [9] Postoperative Delirium in Glioblastoma Patients: Risk Factors and Prognostic Implications
    Flanigan, Patrick M.
    Jahangiri, Arman
    Weinstein, Drew
    Dayani, Fara
    Chandra, Ankush
    Kanungo, Ishan
    Choi, Sarah
    Sankaran, Sujatha
    Molinaro, Annette M.
    McDermott, Michael W.
    Berger, Mitchel S.
    Aghi, Manish K.
    [J]. NEUROSURGERY, 2018, 83 (06) : 1161 - 1172
  • [10] The cost of delirium in the surgical patient
    Franco, K
    Litaker, D
    Locala, J
    Bronson, D
    [J]. PSYCHOSOMATICS, 2001, 42 (01) : 68 - 73