Prediction model for delirium in patients with cardiovascular surgery: development and validation

Abstract

Background The aim of this study was to construct a nomogram model for discriminating the risk of delirium in patients undergoing cardiovascular surgery. Methods From January 2017 to June 2020, we collected data from 838 patients who underwent cardiovascular surgery at the Affiliated Hospital of Nantong University. Patients were randomly divided into a training set and a validation set at a 5:5 ratio. A nomogram model was established based on logistic regression. Discrimination and calibration were used to evaluate the predictive performance of the model. Results The incidence of delirium was 48.3%. A total of 389 patients were in the modelling group, and 449 patients were in the verification group. Logistic regression analysis showed that CPB duration (OR $$=$$ = 1.004, 95% CI: 1.001–1.008, $$P=$$ P = 0.018), postoperative serum sodium (OR $$=$$ = 1.112, 95% CI: 1.049–1.178, $$P<$$ P < 0.001), age (OR $$=$$ = 1.027, 95% CI: 1.006–1.048, $$P=$$ P = 0.011), and postoperative MV (OR $$=$$ = 1.019, 95% CI: 1.008–1.030, $$P<$$ P < 0.001) were independent risk factors. The results showed that AUC$$^\text {ROC}$$ ROC was 0.712 and that the 95% CI was 0.661–0.762. The Hosmer-Lemeshow goodness of fit test showed that the predicted results of the model were in good agreement with the actual situation ($$\chi ^{2}=$$ χ 2 = 6.200, $$P=$$ P = 0.625). The results of verification showed that the AUC$$^\text {ROC}$$ ROC was 0.705, and the 95% CI was 0.657–0.752. The Hosmer-Lemeshow goodness of fit test results were $$\chi ^{2}=$$ χ 2 = 8.653 and $$P=$$ P = 0.372, indicating that the predictive effect of the model is good. Conclusions The establishment of the model provides accurate and objective assessment tools for medical staff to start preventing postoperative delirium in a purposeful and focused manner when a patient enters the CSICU after surgery.

Development of an individualized model for predicting postoperative delirium in elderly patients with hepatocellular carcinoma

“…Age-related constriction of blood vessels reduces cerebral oxygenation, which can potentially lead to postoperative cerebral impairment 35 , 36 . Moreover, alterations in drug metabolism and response owing to aging may increase the adverse effects of medications, thereby increasing the likelihood of POD 37 .…”

Nomogram for predicting of postoperative delirium in elderly patients undergoing radical esophagectomy

“…Therefore, it is crucial to develop an individual predictive model and early identi cation of patients at high risk for delirium. In recent years, some prediction models of POD had been established in hip replacement [23,24], laparoscopic surgery for gynecologic cancers [25], thoracic endovascular aortic repair[26], cardiovascular surgery [27], free ap reconstruction for head and neck cancer[28] and laparoscopic gastrectomy [29]. However, the predictive effect of each prediction model differ sharply, and there is no model to predict the risk of POD in esophageal cancer surgery.…”