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
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