老年营养风险指数在预测老年非心脏手术患者术后谵妄中的应用

Application of geriatric nutritional risk index in predicting postoperative delirium in elderly patients undergoing noncardiac surgery

【摘要】目的 探讨老年营养风险指数(GNRI)在预测老年非心脏手术患者术后谵妄(POD)方面的应用。方法 回顾性分析2022年10月至2023年9月在徐州市中心医院全身麻醉下行非心脏手术的479例老年患者的临床资料,根据临床结局分为谵妄组(n=140)和非谵妄组(n=339)。比较两组患者的患者基本资料、术前实验室指标及各项评估量表。采用多因素logistic回归分析POD的独立危险因素。绘制受试者工作特征(ROC)曲线评估GNRI及其拟合模型在预测老年非心脏手术患者POD中的价值。采用SPSS 26.0和R4.2.3软件进行数据分析。根据数据类型,组间比较分别采用t检验、Mann-Whitney U检验及χ²检验。结果 两组患者在年龄、体质量指数、GNRI、受教育程度、是否入重症监护室、手术类别、贫血程度、查尔森合并症指数(CCI)得分、手术时间、术中液体平衡、术前血红蛋白(Hb)、术前尿酸以及中性粒细胞与淋巴细胞之比(NLR)方面比较,差异有统计学意义(P<0.05)；多因素logistic回归分析结果显示GNRI、年龄、CCI得分、NLR、手术时间是老年非心脏手术患者POD的独立危险因素(P<0.05)。根据多因素logistic回归结果拟合的模型(模型3),其预测POD的ROC曲线下面积为0.893(95%CI 0.862~0.919),特异度和灵敏度分别为81.4%和79.4%。结论 GNRI是老年非心脏手术患者POD的独立预测因子,且对POD的发生有着良好的预测价值。

基金项目:国家自然科学基金(82071903)；徐州市科技计划项目(KC22174)；徐州市医学领军人才培养项目(XWRCHT20210033)；彭城英才—医学青年后备人才培养项目(XWRCHT20220017)

【Abstract】Objective To investigate the application value of geriatric nutritional risk index (GNRI) in predicting postoperative delirium (POD) in elderly patients after noncardiac surgery. Methods A retrospective analysis was conducted on 479 elderly patients undergoing noncardiac surgery under general anesthesia in Xuzhou Central Hospital from October 2022 to September 2023. According to clinical outcomes, they were divided into a delirium group (n=140) and a non-delirium group (n=339). Basic information, preope-rative laboratory indicators and results of evaluation scales were compared between the two groups. Multivariate logistic regression anslysis was applied to identify the independent risk factors for POD, and receiver operating characteristic (ROC) curve was drawn to evaluate the value of GNRI and its fitting model in predicting POD in elderly patients undergoing noncardiac surgery. SPSS statistics 26.0 and R4.2.3 were employed for statistical analysis. Student′s t test, Mann-Whitney U test orχ² test was employed for intergroup comparison depending on data type. Results Significant differences were observed between two groups in terms of age, body mass index (BMI), GNRI, education level, admission to intensive care unit, operative category, degree of anaemia, Charlson comorbidity index (CCI), operation time, intraoperative fluid balance, and preoperative hemoglobin and uric acid levels and neutrophil to lymphocyte ratio (NLR). Multivariate logistic regression showed that GNRI, age, CCI, NLR, and operation time were independent risks for POD in the elderly patients (P<0.05). Based on the results of multivariate logistic regression analysis, the fitted Model 3 had an ROC area under the curve value of 0.893 (95%CI 0.862-0.919) in predicting POD, with a specificity of 81.4% and a sensitivity of 79.4%. Conclusion GNRI is an independent predictor of POD in elderly patients undergoing noncardiac surgery, and has good predictive value for the occurrence of POD.

This work was supported by the National Natural Science Foundation of China (82071903) and the Project of Xuzhou Science and Technology Plan (KC22174), the Xuzhou Medical Leading Talent Training Project (XWRCHT20210033) and the Pengcheng Elite-Reserved Young Medical Talent Training Project (XWRCHT20220017).