衰弱联合血液学参数预测老年脊柱手术术后谵妄的临床价值

Clinical value of combined use of FRAIL scale and hematological parameters in predicting postoperative delirium in elderly patients after spinal surgery

中文关键词:  FRAIL量表  老年  脊柱手术  术后谵妄  衰弱

英文关键词:FRAIL scale  Elderly  Spinal surgery  Postoperative delirium  Frailty

中文摘要:

  【摘要】 目的：探究衰弱联合血液学参数预测老年脊柱手术患者术后谵妄（postoperative delirium，POD）的临床价值。方法：回顾性分析2021年1月1日~2024年12月31日在哈尔滨医科大学附属第一医院骨科行脊柱手术的398例老年患者临床资料。其中男性218例，女性患者180例；年龄63~87岁（72.8±6.3岁）；颈椎手术137例，胸椎手术40例，腰椎手术221例；1级手术21例，2级手术60例，3级手术238例，4级手术79例。根据《精神病的诊断和统计手册》标准判断术后7d时有无谵妄，据此将患者分为POD组和非POD组。提取患者临床资料，包括术前衰弱（FRAIL量表评分≥3分）及血小板、血糖、血红蛋白、降钙素原、白细胞介素-17、白蛋白、血尿酸、C反应蛋白、25-羟维生素Ｄ[25-hydroxy vitamin D，25（OH）D]、中性粒细胞/淋巴细胞比值（neutrophil-to-lymphocyte ratio，NLR）、C 反应蛋白/白蛋白比值（C-reactive protein albumin ratio，CAR）等血液学指标，采用多因素Logistic回归模型分析POD的危险因素，并采用ROC曲线分析衰弱联合CAR、25（OH）D预测POD的价值。结果：POD组122例，非POD组276例。术前93例患者衰弱（FRAIL量表≥3分），305例无衰弱（FRAIL量表＜3分）。与非POD组比较，POD组年龄及术前衰弱比率、血清降钙素原、尿酸、CAR水平更高，手术时间更长，血清25-羟维生素Ｄ[25（OH）D]更低，有统计学差异（P＜0.05）。多因素Logistic回归模型发现，术前衰弱（OR=1.645，95%CI:1.280~2.116）、CAR（OR=1.508，95%CI：1.201~1.894）是老年脊柱手术患者发生POD的独立危险因素，而25（OH）D为保护性因素（OR=0.694，95%CI：0.541~0.891）。单一衰弱、CAR、25（OH）D预测POD的曲线下面积（area under curve，AUC）分布于0.687~0.790，而三者联合预测的AUC为0.868（95%CI：0.832~0.904），敏感性为79.51%，特异性为80.07%。结论：衰弱、CAR、25（OH）D是老年脊柱手术患者发生POD的独立影响因素，三者联合应用对POD具有良好的预测能力。

英文摘要:

  【Abstract】 Objectives: To investigate the clinical value of the FRAIL scale combined with multiple hematological indicators in predicting postoperative delirium(POD) in elderly patients undergoing spinal surgery. Methods: The clinical data of 398 elderly patients who underwent spinal surgery at the Department of Orthopedics, the First Affiliated Hospital of Harbin Medical University were retrospectively analyzed. Among them, 218 were male and 180 were female; with an age range of 63 to 87(72.8±6.3) years; 137 underwent cervical spine surgery, 40 underwent thoracic spine surgery, and 221 underwent lumbar spine surgery; 21 surgeries were classified as Level 1, 60 as Level 2, 238 as Level 3, and 79 as Level 4. Based on the Diagnostic and Statistical Manual of Mental Disorders criteria, the patients were assessed to be with or without delirium on postoperative 7d, and were divided into a POD group and a non-POD group. The clinical data of the patients were extracted, including preoperative frailty(FRAIL scale score≥3 points) and hematological indicators such as platelets, blood glucose, hemoglobin, procalcitonin, interleukin-17, albumin, blood uric acid, C-reactive protein, 25-hydroxy vitamin D[25(OH)D], neutrophil-to-lymphocyte ratio(NLR), and C-reactive protein/albumin ratio(CAR). Multivariate logistic regression was performed to analyze risk factors for POD, while ROC curves were used to evaluate the predictive value of combined frailty, CAR and 25(OH)D. Results: There were 122 cases in the POD group and 276 cases in the non-POD group. Before operation, 93 patients were frail(FRAIL scale≥3 points), and 305 patients were not frail(FRAIL scale<3 points). Compared with the non-POD group, the POD group exhibited significantly older age, higher preoperative frailty rates, serum procalcitonin, uric acid, and CAR levels, longer operative time, and lower serum 25(OH)D levels(P<0.05). Multivariate logistic regression analysis identified preoperative frailty(OR=1.645, 95%CI: 1.280-2.116) and CAR(OR=1.508, 95%CI: 1.201-1.894) were independent risk factors for POD in elderly patients undergoing spinal surgery, while 25(OH)D was a protective factor(OR=0.694, 95%CI: 0.541-0.891). The AUC for predicting POD using frailty, CAR, or 25(OH)D alone ranged from 0.687 to 0.790, whereas the combined AUC for all three factors was 0.868(95%CI: 0.832-0.904), with sensitivity of 79.51% and specificity of 80.07%. Conclusions: Frailty, CAR, and 25(OH)D are independent risk factors for POD in elderly patients undergoing spinal surgery, and the combination of the three has a good predictive ability for POD.