Construction of a column chart model for predicting postoperative delirium in patients with lumbar vertebral fractures based on novel inflammatory composite scoring
Received date: 2023-06-12
Online published: 2023-10-10
目的 探究采用新型炎症复合评分系统,建立列线图模型预测腰椎骨折患者术后谵妄的风险。 方法 选取2020年6月至2022年12月我院收治并进行手术治疗的251例腰椎骨折患者为研究对象,根据患者情况将其分为术后谵妄组(n = 55)和无谵妄组(n = 196)。记录两组患者的临床资料并进行单因素分析;ROC曲线分析指标对腰椎骨折患者术后谵妄的预测价值;logistic回归分析术后谵妄的独立危险因素并构建列线图模型,校正曲线对模型进行内部验证,计算一致性指数(concordance index, C-index),决策曲线评估模型预测效能。 结果 两组患者在年龄、手术时间、术中出血量、炎症反应标志物NLR、PLR、CAR方面的差异有统计学意义(P < 0.05)。年龄、手术时间、术中出血量、NLR、PLR、CAR的AUC分别为0.788、0.714、0.797、0.824、0.839、0.811;构建N.P.Cs评分标准,其AUC为0.963。年龄、术中出血量、N.P.Cs是影响腰椎骨折患者术后谵妄的独立危险因素。列线图预测模型的校正曲线与原始曲线及理想曲线接近,C-index为0.847(95% CI:0.811 ~ 0.903);列线图预测模型的阈值> 0.17,可提供临床净收益。 结论 年龄、术中出血量、N.P.Cs是影响腰椎骨折患者术后谵妄的独立危险因素,基于此构建的列线图预测模型可为腰椎骨折患者术后谵妄的防治提供指导。
徐梦馨 , 王唯 , 戴荣兄 . 基于新型炎症复合评分构建预测腰椎骨折患者术后谵妄的列线图模型[J]. 实用医学杂志, 2023 , 39(18) : 2306 -2311 . DOI: 10.3969/j.issn.1006-5725.2023.18.004
Objective To explore the use of a novel inflammatory composite scoring system with a column chart model to predict the risk of postoperative delirium in patients with lumbar spine fractures. Methods 251 patients with lumbar spine fracture who had been admitted to our hospital and had undergone surgical treatment from June 2020 to December 2022 were selected as study subjects, and then divided into a postoperative delirium group (n = 55) and a delirium-free group (n = 196) according to the patients' conditions. The clinical data of the two groups were recorded and subjected to univariate analysis. ROC curve was used to analyze the predictive value of the indexes for postoperative delirium in the patients; logistic regression was used to analyse the independent risk factors for postoperative delirium and construct a columnar graph model; the calibration curves were used for the internal validation of the model; the consistency index (C-index) was calculated; and the decision curve was used to evaluate the predictive efficiency of the model. Results The differences between the two groups in terms of age, surgical duration, intraoperative bleeding, and inflammatory response markers NLR, PLR, and CAR were statistically significant (P < 0.05). The AUCs of age, surgical time, intraoperative bleeding, NLR, PLR, and CAR were 0.788, 0.714, 0.797, 0.824, 0.839, and 0.811, respectively; and the AUC of the constructed N.P.Cs scoring scale was 0.963. Age, intraoperative bleeding, and N.P.Cs were independent risk factors affecting postoperative delirium in patients with lumbar spine fractures. The calibration curve of the column-line diagram prediction model was close to the original and ideal curves, with a C-index of 0.847 (95% CI:0.811 ~ 0.903); the threshold value of the column-line diagram prediction model was greater than 0.17, providing a net clinical benefit. Conclusion Age, intraoperative bleeding, and N.P.Cs are independent risk factors for postoperative delirium in patients with lumbar spine fractures. The column chart prediction model based on this construction can provide guidance for the prevention and treatment of postoperative delirium in patients with lumbar spine fractures.
| 1 | SPIEGL U J A, SCHNAKE K J, HARTMANN F, et al.Traumatic Fractures of the Thoracic Spine[J]. Z Orthop Unfall,2021,159(4):373-382. |
| 2 | SPIEGL U, BORK H, GRüNINGER S, et al. Osteoporotic Fractures of the Thoracic and Lumbar Vertebrae:Diagnosis and Conservative Treatment[J]. Dtsch Arztebl Int,2021,118(40):670-677. |
| 3 | LAMAIDA G A, RUOSI C, MISAGGI B. Indications for the monosegmental stabilization of thoraco-lumbar spine fractures[J].Int Orthop, 2019,43(1):169-176. |
| 4 | 党慧,秦艳霞. 动机性访谈联合赋能教育对老年骨质疏松性胸腰椎骨折患者术后康复的影响[J]. 临床医学研究与实践,2022,7(34):190-192. |
| 5 | DEVLIN J W, SKROBIK Y, GéLINAS C, et al. Executive Summary: Clinical Practice Guidelines for the Prevention and Management of Pain,Agitation/Sedation,Delirium,Immobility,and Sleep Disruption in Adult Patients in the ICU[J]. Crit Care Med,2018,46(9):1532-1548. |
| 6 | BERIAN J R, ZHOU L, RUSSELL M M, et al. Postoperative Delirium as a Target for Surgical Quality Improvement[J]. Ann Surg,2018,268(1):93-99. |
| 7 | MAZZUCCHI E. Both the nomogram and the score system can represent an useful tool especially in those cases where the complication is foreseen by the surgeon[J]. Int Braz J Urol, 2022,48(5):828-829. |
| 8 | 潘登,张长江,李洪珂,等. 胸腰椎多节段脊柱骨折的临床诊断及治疗探讨[J]. 中国医药指南, 2014, 12(11):94-95. |
| 9 | 代党会,陈燕,李军,等. 镇静深度对老年骨折患者术后认知功能及谵妄发生率的影响[J]. 国际精神病学杂志, 2020,47(1):129-132. |
| 10 | 黄晓东,陈昌红. 骨水泥强化椎弓根钉内固定术对老年骨质疏松性胸腰椎骨折的疗效[J]. 实用医学杂志, 2022,38(22):2813-2816,2821. |
| 11 | 郑光明,谭赞全,张兰蓉. 髂筋膜间室阻滞超前镇痛对围手术期老年髋部骨折谵妄影响的研究[J]. 中国实用医药, 2019,14(3):103-104. |
| 12 | 叶磊,张爱琴,荣芸,等. 老年髋部骨折患者术后谵妄风险预测模型的系统评价[J]. 护理学报, 2023,30(7):48-52. |
| 13 | 吴克义,黄勇,许成浩,等. 艾司氯胺酮用于老年胸腰椎骨折手术对患者术中血流动力学和术后谵妄的影响[J]. 颈腰痛杂志, 2023,44(3):361-365. |
| 14 | 蒋云雯,胡皎,高慧秋,等. 围术期快速康复护理模式对老年股骨颈骨折术后谵妄及康复质量的影响[J]. 实用医学杂志,2021,37(3):405-409. |
| 15 | IASONOS A, SCHRAG D, RAJ G V,et al. How to build and interpret a nomogram for cancer prognosis[J]. J Clin Oncol, 2008,26(8):1364-1370. |
| 16 | 文新平,贾黎,韩英华,等. 术前营养不良与老年人髋部骨折术后谵妄的相关性研究[J]. 实用老年医学, 2020,34(5):451-453,461. |
| 17 | 王树相,陈鑫磊,徐超. 个体化预测老年髋部骨折患者术后谵妄风险[J]. 中国矫形外科杂志, 2019,27(6):542-548. |
| 18 | 赵小燕,张伟,王晋平,等. 术前修正衰弱指数联合C反应蛋白/白蛋白比值、中性粒细胞/淋巴细胞比值对老年结直肠癌患者术后谵妄发生风险的评估价值[J]. 现代生物医学进展,2022,22(19):3735-3739. |
| 19 | QI J, LIU C, CHEN L, et al. Postoperative Serum Albumin Decrease Independently Predicts Delirium in the Elderly Subjects after Total Joint Arthroplasty[J]. Curr Pharm Des, 2020,26(3):386-394. |
| 20 | ZHANG R, WU X, HU W, et al. Neutrophil-to-lymphocyte ratio predicts hemorrhagic transformation in ischemic stroke:A meta-analysis[J]. Brain Behav, 2019,9(9):e01382. |
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