Nomogram to predict postoperative cognitive dysfunction in elderly patients undergoing gastrointestinal tumor resection

Abstract

ObjectiveTo establish a nomogram model for the prediction of postoperative cognitive dysfunction (POCD) in elderly patients undergoing gastrointestinal tumor resection.MethodsA total of 369 elderly patients scheduled for elective gastrointestinal tumor resection under general anesthesia were included. The cognitive function of each participant was assessed by the Mini-Mental State Examination (MMSE) 1 day before surgery and 7 days after surgery for the diagnosis of POCD. According to the results, patients were divided into a POCD group and a non-POCD group. The differences in hospitalization data and examination results between the two groups were compared. A logistic regression model was used to explore the risk factors for POCD in elderly patients undergoing gastrointestinal tumor resection, and a nomogram was then constructed based on these factors. The diagnostic performance of the nomogram was evaluated using the area under the receiver operating characteristic curve (AUROC) and a calibration plot. The clinical usefulness of the nomogram was estimated using decision curve analysis (DCA).ResultsAmong the 369 patients undergoing gastrointestinal tumor resection, 79 patients had POCD, with a positive rate of 21.4%. The nomogram model comprised the following variables: age, body mass index (BMI), history of cerebrovascular disease, preoperative white blood cell (WBC) count, preoperative hemoglobin (Hb) level, intra-operative blood loss, and operation time. The model showed good discrimination, with an area under the curve (AUC) of 0.710 (95% CI = 0.645–0.775), and good calibration (Hosmer–Lemeshow test, χ2 = 5.133, p = 0.274). Internal validation also maintained ideal discrimination and calibration. Decision curves indicated that when the threshold probability was above 0.1, the nomogram achieved more benefit than both the treat-all and treat-none policies.ConclusionThis scoring system is the first nomogram model developed for the prediction of POCD in elderly patients undergoing gastrointestinal tumor resection. It has good efficacy in the prediction of POCD risk and could provide an important reference for the prevention, management, and treatment of POCD.

An immune signature of postoperative cognitive decline in elderly patients

“…The predictive model of POCD contained 11 single-cell and plasma proteomic features. Notably, the model lacked clinical parameters, consistent with the limited performance (AUC < 0.7) of previous predictive models of POCD based on pre-or post-operative clinical factors( 10 ). The results underscore the importance of integrating biological variables that capture the pathophysiology of cognitive impairments into accurate prognostic assays( 11 ) that can be leveraged for the personalized management of patients at risk for POCD.…”

“…In addition, the model included a single plasma proteomic feature, chemokine CXCL1 (0.43 -log2 fold difference in median expression), a potent chemoattractant known to be implicated in neuroinflammatory processes such as Alzheimer's disease (44). Interestingly, the predictive model did not select clinical features, consistent with the inability of previous clinical studies to accurately predict POCD from preoperative clinical data (10).…”

“…Although there is currently no specific treatment for POCD, a preventive approach including cognitive prehabilitation training, physical exercise, and preoperative geriatric consultation has demonstrated efficacy in mitigating POCD risk (7)(8)(9). However, estimating an individual patient's POCD risk remains challenging as previous attempts relying on clinical factors have yielded limited predictive power (10), severely impeding implementation of preventative interventions. Accurate biological or clinical biomarkers of POCD are urgently needed to develop a prognostic test to guide personalized management of elderly surgical patients (11).…”

Tryptophan-rich diet and its effects on brain Tregs in alleviating neuroinflammation and cognitive impairment

“…3 Department of Anesthesiology, Chinese People's Armed Police Force Hospital of Beijing, Beijing 100027, China. 4 Department of Pain Medicine, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China.…”

“…Research indicates that the incidence of cognitive impairment one week after noncardiac surgery in elderly patients reaches 25.8%, with a persistently high rate of 9.9% after three months. In certain cases, these impairments may persist for more than a year, ultimately leading to progression to elderly dementia [4]. The impact of PND, especially long-term PND, extends beyond the individual's health, affecting the rehabilitation process and resulting in prolonged hospital stays, increased medical expenses, diminished quality of life, and elevated mortality rates.…”