Risk factors and a nomogram model for postoperative delirium in elderly gastric cancer patients after laparoscopic gastrectomy

Abstract

Background To evaluate the risk factors of postoperative delirium (POD) in elderly gastric cancer (GC) patients after laparoscopic gastrectomy and construct a predictive model. Methods Elderly GC patients undergoing laparoscopic gastrectomy were enrolled and grouped based on the status of POD development within postoperative 7 days. Independent risk factors were selected out by univariate and multivariate logistic regression analyses and then enrolled in the nomogram prediction model. Results A total of 270 elderly GC patients were enrolled, and POD occurred in 74 (27.4%) patients within postoperative 7 days. The results of multivariate regression analysis indicated that age (OR: 3.30, 95% CI: 1.41–6.85, P < 0.001), sleeping pills (OR: 1.87, 95% CI: 1.12–3.09, P = 0.012), duration of ICU stay (OR: 1.55, 95% CI: 1.02–2.37, P = 0.029), albumin/fibrinogen ratio (AFR) (OR: 1.74, 95% CI: 1.03–2.76, P = 0.019), and neutrophils/lymphocytes ratio (NLR) (OR: 2.12, 95% CI: 1.11–4.01, P = 0.016) were five independent risk factors for POD in elderly GC patients. The AUC of the constructed nomogram model based on these five factors was 0.807. Conclusions This study highlighted that age, AFR, NLR, sleeping pills taking, and duration of ICU stay were independent risk factors for POD, and the nomogram model based on these factors could effectively predict POD in elderly GC patients.

Combining systemic inflammatory response index and albumin fibrinogen ratio to predict early serious complications and prognosis after resectable gastric cancer

“…Similarly, related research has demonstrated that AFR can predict the prognoses of patients with pancreatic cancer[ 51 ], gallbladder cancer[ 59 ], and colorectal cancer[ 60 ]. Chen et al [ 61 ] reported that AFR was a distinct risk factor for postoperative delirium in senior gastric cancer patients who underwent laparoscopic gastrectomy, with a cut-off value of 9.95 and an AUC area of 0.614. You et al [ 25 ] found that major postoperative complications in senior gastric cancer patients after laparoscopic radical gastrectomy were predicted by the preoperative AFR.…”

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

“…An advanced age has been widely accepted as a major demography-related preoperative risk factor affecting the onset of POD in several studies [41][42][43][44]. As the increase of age, degeneration of compensatory physiological mechanisms and organ function, remarkably reduced body adaptability to drastic alterations during the surgical period leaded to a signi cantly increased risk of POD [29]. In addition, the older patients may be associated with brain atrophy, gradual neurodegeneration, decreased cerebral neurotransmitters production, the narrowing of cerebral vessels due to endothelial dysfunction and atherosclerosis, making older patients more susceptible to POD [45,46].…”

“…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.…”

Immune Cell Ratios Are Higher in Bipolar Affective than Unipolar Depressive Disorder and Modulated by Mood Episode: A Retrospective, Cross-Sectional Study

“…ICRs have been also investigated in various disorders of the central nervous system, such as delirium, Parkinson’s disease, Alzheimer’s disease, multiple sclerosis, and schizophrenia [ 42 , 43 , 44 , 45 , 46 ]. Regarding affective disorders, it was not until 2015, when Demir et al and Cakir et al first investigated NLR in MDD and BD respectively, and both reported higher levels of NLR in MDD and BD patients compared to healthy controls [ 47 , 48 ].…”