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CNS Neuroscience & Therapeutics Oct 2023Machine learning-based identification of key variables and prediction of postoperative delirium in patients with extensive burns.
AIMS
Machine learning-based identification of key variables and prediction of postoperative delirium in patients with extensive burns.
METHODS
Five hundred and eighteen patients with extensive burns who underwent surgery were included and randomly divided into a training set, a validation set, and a testing set. Multifactorial logistic regression analysis was used to screen for significant variables. Nine prediction models were constructed in the training and validation sets (80% of dataset). The testing set (20% of dataset) was used to further evaluate the model. The area under the receiver operating curve (AUROC) was used to compare model performance. SHapley Additive exPlanations (SHAP) was used to interpret the best one and to externally validate it in another large tertiary hospital.
RESULTS
Seven variables were used in the development of nine prediction models: physical restraint, diabetes, sex, preoperative hemoglobin, acute physiological and chronic health assessment, time in the Burn Intensive Care Unit and total body surface area. Random Forest (RF) outperformed the other eight models in terms of predictive performance (ROC:84.00%) When external validation was performed, RF performed well (accuracy: 77.12%, sensitivity: 67.74% and specificity: 80.46%).
CONCLUSION
The first machine learning-based delirium prediction model for patients with extensive burns was successfully developed and validated. High-risk patients for delirium can be effectively identified and targeted interventions can be made to reduce the incidence of delirium.
Topics: Humans; Intensive Care Units; Machine Learning; Random Forest; Delirium
PubMed: 37122154
DOI: 10.1111/cns.14237 -
Frontiers in Neurology 2023To analyze the incidence, timing, risk factors and prognosis of delirium after liver transplantation (LT).
OBJECTIVE
To analyze the incidence, timing, risk factors and prognosis of delirium after liver transplantation (LT).
METHODS
The clinical data of 321 patients undergoing LT in the Third Xiangya Hospital of Central South University from January 2018 to December 2022 were collected to investigate the incidence, onset, and risk factors for post-LT delirium and the impact of delirium on LT recipients' prognosis by statistical analysis.
RESULTS
The incidence of post-LT delirium was 19.3% (62/321), and the median interval between LT and onset of delirium was 20.1 h. Univariate analysis showed that pre-LT variables (Model for End Stage Liver Disease (MELD) score, hospital stay, hepatic encephalopathy, infection, white blood cell (WBC) count, lymphocyte count, abnormal potassium, lactulose use), intraoperative variables (red blood cell transfusion, remimazolam use, dexmedetomidine use) and post-LT variables (hypernatraemia, acute rejection, reoperation, basiliximab use, tacrolimus concentration) were associated with post-LT delirium. Multivariate logistic regression analysis revealed that MELD score at LT ≥22 [OR = 3.400, 95% CI:1.468-7.876, = 0.004], pre-LT hepatic encephalopathy [OR = 3.224, 95% CI:1.664-6.244, = 0.001], infection within 2 months prior to LT [OR = 2.238, 95% CI:1.151-4.351, = 0.018], acute rejection [OR = 2.974, 95% CI:1.322-6.690, = 0.008], and reoperation [OR = 11.919, 95% CI:2.938-48.350, = 0.001] were independent risk factors for post-LT delirium. Post-LT delirium was reduced in LT recipients exposing to intraoperative remimazolam [OR = 0.287, 95% CI: 0.113-0.733, = 0.009] or ≥ 25 μg of intraoperative dexmedetomidine [OR = 0.441, 95% CI 0.225-0.867, = 0.018]. As for clinical outcomes, patients with delirium had a higher percentage of staying at the (ICU) ≥7 d after LT than those without delirium [OR = 2.559, 95% CI 1.418-4.617, = 0.002].
CONCLUSION
The incidence of delirium was high and the onset of delirium was early after LT. Risk factors for post-LT delirium included high MELD score at LT, pre-LT hepatic encephalopathy and infections, acute rejection and reoperation. Intraoperative use of remimazolam or dexmedetomidine reduced post-LT delirium. Delirium had a negative impact on the length of ICU stay.
PubMed: 37869144
DOI: 10.3389/fneur.2023.1229990 -
BMC Geriatrics Nov 2023Postoperative delirium (POD) is an important complication for older patients and recent randomised controlled trials have showed a conflicting result of the effect of... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Postoperative delirium (POD) is an important complication for older patients and recent randomised controlled trials have showed a conflicting result of the effect of deep and light anesthesia.
METHODS
We included randomised controlled trials including older adults that evaluated the effect of anesthetic depth on postoperative delirium from PubMed, Embase, Web of Science and Cochrane Library. We considered deep anesthesia as observer's assessment of the alertness/ sedation scale (OAA/S) of 0-2 or targeted bispectral (BIS) < 45 and the light anesthesia was considered OAA/S 3-5 or targeted BIS > 50. The primary outcome was incidence of POD within 7 days after surgery. And the secondary outcomes were mortality and cognitive function 3 months or more after surgery. The quality of evidence was assessed via the grading of recommendations assessment, development, and evaluation approach.
RESULTS
We included 6 studies represented 7736 patients aged 60 years and older. We observed that the deep anesthesia would not increase incidence of POD when compared with the light anesthesia when 4 related studies were pooled (OR, 1.40; 95% CI, 0.63-3.08, P = 0.41, I = 82%, low certainty). And no significant was found in mortality (OR, 1.12; 95% CI, 0.93-1.35, P = 0.23, I = 0%, high certainty) and cognitive function (OR, 1.13; 95% CI, 0.67-1.91, P = 0.64, I = 13%, high certainty) 3 months or more after surgery between deep anesthesia and light anesthesia.
CONCLUSIONS
Low-quality evidence suggests that light general anesthesia was not associated with lower POD incidence than deep general anesthesia. And High-quality evidence showed that anesthetic depth did not affect the long-term mortality and cognitive function.
SYSTEMATIC REVIEW REGISTRATION
CRD42022300829 (PROSPERO).
Topics: Humans; Middle Aged; Aged; Emergence Delirium; Delirium; Anesthetics; Anesthesia, General; Cognition; Postoperative Complications
PubMed: 37932677
DOI: 10.1186/s12877-023-04432-w -
Frontiers in Endocrinology 2023Delirium significantly contributes to both mortality and morbidity among hospitalized older adults. Furthermore, delirium leads to escalated healthcare expenditures,...
BACKGROUND
Delirium significantly contributes to both mortality and morbidity among hospitalized older adults. Furthermore, delirium leads to escalated healthcare expenditures, extended hospital stays, and enduring cognitive deterioration, all of which are acknowledged detrimental outcomes. Nonetheless, the current strategies for predicting and managing delirium remain constrained. Our aim was to employ Mendelian randomization (MR) to investigate the potential causal relationship between metabolites and delirium, as well as to identify potential therapeutic targets.
METHODS
We identified 129 distinct blood metabolites from three genome-wide association studies (GWASs) conducted on the metabolome, involving a total of 147,827 participants of European descent. Genetic information pertaining to delirium was sourced from the ninth iteration of the Finngen Biobank, encompassing 359,699 individuals of Finnish ancestry. We conducted MR analyses to evaluate the connections between blood metabolites and delirium. Additionally, we extended our analysis to encompass the entire phenome using MR, aiming to uncover potential on-target consequences resulting from metabolite interventions.
RESULTS
In our investigation, we discovered three metabolites serving as causal mediators in the context of delirium: clinical low density lipoprotein cholesterol (LDL-C) (odds ratio [OR]: 1.47, 95% confidence interval [CI]: 1.25-1.73, = 3.92 x 10), sphingomyelin (OR: 1.47, 95% CI: 1.25-1.74, = 5.97 x 10), and X-11593-O-methylascorbate (OR: 0.21, 95% CI: 0.10-0.43, = 1.86 x 10). Furthermore, utilizing phenome-wide MR analysis, we discerned that clinical LDL-C, sphingomyelin, and O-methylascorbate not only mediate delirium susceptibility but also impact the risk of diverse ailments.
LIMITATIONS
(1) Limited representation of the complete blood metabolome, (2) reliance on the PheCode system based on hospital diagnoses may underrepresent conditions with infrequent hospital admissions, and (3) limited to European ancestry.
CONCLUSION
The genetic prediction of heightened O-methylascorbate levels seems to correspond to a diminished risk of delirium, in contrast to the association of elevated clinical LDL-C and sphingomyelin levels with an amplified risk. A comprehensive analysis of side-effect profiles has been undertaken to facilitate the prioritization of drug targets. Notably, O-methylascorbate emerges as a potentially auspicious target for mitigating and treating delirium, offering the advantage of lacking predicted adverse side effects.
Topics: Humans; Aged; Cholesterol, LDL; Risk Factors; Mendelian Randomization Analysis; Genome-Wide Association Study; Sphingomyelins; Delirium
PubMed: 38274231
DOI: 10.3389/fendo.2023.1332712 -
JAMA Network Open Oct 2023Perioperative neurocognitive disorder, particularly postoperative cognitive impairment, is common and associated with multiple medical and social adversities, although...
IMPORTANCE
Perioperative neurocognitive disorder, particularly postoperative cognitive impairment, is common and associated with multiple medical and social adversities, although data from China are lacking.
OBJECTIVE
To examine the incidence, trajectory, and risk factors for subjective cognitive and short-term memory impairment after surgery in the Chinese population.
DESIGN, SETTING, AND PARTICIPANTS
This cohort study used data from the China Surgery and Anesthesia Cohort to assess surgical patients aged 40 to 65 years from 2 medical centers between July 15, 2020, and March 31, 2023, with active follow-up within 1 year after the surgery. Of 11 158 patients who were successfully recruited (response rate, 94.4%), 10 149 participants were eligible and available for analysis. From this population, separate cohorts were constructed for analyzing subjective cognitive impairment (8105 noncardiac and 678 cardiac surgery patients) and short-term memory impairment (5246 noncardiac and 454 cardiac surgery patients).
EXPOSURES
Twenty-four potential risk factors regarding comorbidities, preoperative psychological conditions, anesthesia- or surgery-related factors, and postsurgical events were included.
MAIN OUTCOMES AND MEASURES
Outcomes included subjective cognitive function measured by the 8-Item Informant Interview to Differentiate Aging and Dementia (AD8; scores range from 0 to 8, with higher scores indicating more severe cognitive impairment) and short-term memory measured by the 3-Word Recall Test (TRT; scores range from 0 to 3, with lower scores indicating more severe short-term memory impairment) at 1, 3, 6, and 12 months after noncardiac and cardiac surgery. Generalized linear mixed models were used to identify risk factors associated with the presence of AD8 (score ≥2) or TRT (score <3) abnormality as well as the aggressively deteriorative trajectories of those cognitive measurements.
RESULTS
For noncardiac surgery patients, the AD8 analysis included 8105 patients (mean [SD] age, 52.3 [7.1] years; 3378 [41.7%] male), and the TRT analysis included 5246 patients (mean [SD] age, 51.4 [7.0] years; 1969 [37.5%] male). The AD8 abnormality incidence rates after noncardiac surgery increased from 2.2% (175 of 8105) at 7 days to 17.1% (1059 of 6191) at 6 months after surgery, before appearing to decrease. In contrast, the TRT abnormality incidence rates followed a U-shaped pattern, with the most pronounced incidence rates seen at 7 days (38.9% [2040 of 5246]) and 12 months (49.0% [1394 of 2845]). Similar patterns were seen among cardiac surgery patients for the AD8 analysis (678 patients; mean [SD] age, 53.2 [6.3] years; 393 [58.0%] male) and TRT analysis (454 patients; mean [SD] age, 52.4 [6.4] years; 248 [54.6%] male). Among noncardiac surgery patients, the top risk factors for aggressively deteriorative AD8 trajectory and for AD8 abnormality, respectively, after surgery were preoperative sleep disturbances (Pittsburgh Sleep Quality Index ≥16 vs 0-5: odds ratios [ORs], 4.04 [95% CI, 2.20-7.40] and 4.54 [95% CI, 2.40-8.59]), intensive care unit stay of 2 days or longer (ORs, 2.43 [95% CI, 1.26-4.67] and 3.07 [95% CI, 1.67-5.65]), and preoperative depressive symptoms (ORs, 1.76 [95% CI, 1.38-2.24] and 2.23 [95% CI, 1.79-2.77]). Analyses for TRT abnormality and trajectory, as well as the analyses conducted among cardiac surgery patients, found fewer associated factors.
CONCLUSIONS AND RELEVANCE
This cohort study of middle-aged Chinese surgery patients found subjective cognitive and short-term memory impairment within 12 months after both cardiac and noncardiac surgery, with multiple identified risk factors, underscoring the potential of preoperative psychological interventions and optimized perioperative management for postoperative cognitive impairment prevention.
Topics: Female; Humans; Male; Middle Aged; Cognition; Cognitive Dysfunction; Cohort Studies; Delirium; East Asian People; Memory, Short-Term; Adult; Aged; Postoperative Cognitive Complications; Memory Disorders; Surgical Procedures, Operative
PubMed: 37815831
DOI: 10.1001/jamanetworkopen.2023.36985 -
BMC Geriatrics Oct 2023The triglyceride-glucose index (TyG), an established indicator of insulin resistance, is closely correlated with the prognosis of several metabolic disorders. This study...
BACKGROUND
The triglyceride-glucose index (TyG), an established indicator of insulin resistance, is closely correlated with the prognosis of several metabolic disorders. This study aims to investigate the association between the TyG index and the incidence of critical delirium in patients aged 65 years and older.
METHODS
We focused on evaluating patients aged 65 years and older diagnosed with critical delirium. Data were obtained from the Medical Information Database for Intensive Care (MIMIC-IV) and the eICU Collaborative Research Database (eICU-CRD). Multivariate logistic regression and restricted cubic spline (RCS) regression were used to determine the relationship between the TyG index and the risk of delirium.
RESULTS
Participants aged 65 years and older were identified from the MIMIC-IV (n = 4,649) and eICU-CRD (n = 1,844) databases. Based on optimal thresholds derived from RCS regression, participants were divided into two cohorts: Q1 (< 8.912), Q2 (≥ 8.912). The logistic regression analysis showed a direct correlation between the TyG index and an increased risk of critical delirium among ICU patients aged 65 and older. These findings were validated in the eICU-CRD dataset, and sensitivity analysis further strengthened our conclusions. In addition, the subgroup analysis revealed certain differences.
CONCLUSION
This study highlights a clear, independent relationship between the TyG index and the risk of critical delirium in individuals aged 65 years and older, suggesting the importance of the TyG index as a reliable cardio-cerebrovascular metabolic marker for risk assessment and intervention.
Topics: Humans; Critical Care; Databases, Factual; Glucose; Triglycerides; Delirium; Blood Glucose; Biomarkers; Risk Factors
PubMed: 37904099
DOI: 10.1186/s12877-023-04420-0 -
European Journal of Oncology Nursing :... Dec 2023Delirium is a prevalent neuropsychiatric syndrome in older people with cancer. However, there are no meta-analyses assessing its incidence exclusively in this... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Delirium is a prevalent neuropsychiatric syndrome in older people with cancer. However, there are no meta-analyses assessing its incidence exclusively in this population. This study aims to assess the incidence proportion of delirium in older people with cancer in the hospital area.
METHODS
A systematic review and meta-analysis were carried out. MEDLINE, Scopus, and EBSCO were searched from inception to December 2021. PRISMA guidelines were followed. Inclusion criteria were original peer-reviewed studies with experimental (randomised controlled trials), observational, and cross-sectional designs assessing delirium older inpatients (≥65 years) with oncological diseases in medical and post-surgical hospital areas and using validated screening or diagnostic methods. A web-based system was used to manage the screening process. Study quality was assessed with Joanna Briggs Institute Critical Appraisal tools. The statistical analysis was performed in RevMan v5.4.0 (Cochrane Collaboration, Oxford, UK), using a random-effects model to calculate incidence and 95% confidence intervals (CIs).
RESULTS
Based on 37 included articles, the incidence proportion of delirium ranged from 3.8% to 61.4%, in a total of 11,847 older patients with cancer. Meta-analysis showed a pooled incidence of 22.6% (95% confidence interval 18.5%, 26.7%; I = 97%, p < 0.001). The main tools for detection were the Diagnostic Statistical Manual criteria and the Confusion Assessment Methods scale.
CONCLUSIONS
The incidence proportion of delirium in older inpatients with cancer is 22.6%. Incidence in the medical setting was higher than in the post-surgical areas. There is a need for high-quality studies examining delirium in older people with cancer.
Topics: Humans; Aged; Delirium; Incidence; Cross-Sectional Studies; Neoplasms
PubMed: 37976755
DOI: 10.1016/j.ejon.2023.102457 -
European Geriatric Medicine Dec 2023In the FACE Delirium trial, we investigated the feasibility of a structured FAmily-CEntered delirium prevention and treatment during the corona pandemic.
PURPOSE
In the FACE Delirium trial, we investigated the feasibility of a structured FAmily-CEntered delirium prevention and treatment during the corona pandemic.
METHODS
Patients hospitalized in a German geriatric medicine department were included in this single-center, prospective, single-arm feasibility study. Their relatives received a short training on delirium and volunteers or paid staff members facilitated video calls. The primary endpoint was reached when contact between patients and their relatives occurred on ≥ 80% of treatment days, either via video call or visit.
RESULTS
38 patients were included (age 83.0 ± 5.9 years; 73.7% women). 76.3% reached the primary endpoint. Due to the pandemic, 99.3% of the contacts were video calls with a duration of 24.8 ± 16.3 min.
CONCLUSION
Family-centered delirium prevention and treatment using video calls is feasible among hospitalized geriatric patients. Daily implementation in clinical practice poses challenges and requires motivated and qualified staff.
Topics: Humans; Female; Aged; Aged, 80 and over; Male; Prospective Studies; Hospitalization; Delirium
PubMed: 37647011
DOI: 10.1007/s41999-023-00854-2 -
Revista Latino-americana de Enfermagem 2023to describe a microtheory for nursing care in the prevention of delirium in older adult in the intensive care unit. (Review)
Review
OBJECTIVE
to describe a microtheory for nursing care in the prevention of delirium in older adult in the intensive care unit.
METHOD
prescriptive theoretical research, based on substruction. Roy's Adaptation Model constructs were deduced and data from the phenomenon of nursing care in the prevention of delirium in older adult in intensive care were induced, based on an integrative literature review.
RESULTS
the microtheory has a theoretical and operational system and a model of care. In the theoretical system, Roy's focal and contextual stimulus constructs were used. From them, the concepts of focal and contextual care and the variable adaptive response to prevention were elaborated. From the relational statements, four axioms, two postulates, eight propositions and an epistemic assumption were elaborated.
TWO EMPIRICAL INDICATORS WERE ESTABLISHED IN THE OPERATING SYSTEM
the Confusion Assessment Method for Intensive Care Units and the demographic/clinical history of the older adult. Subsequently, two transformational statements, four hypotheses and the model of care represented in figure were produced.
CONCLUSION
the microtheory produced prescribes care in the prevention of delirium in older adult in intensive care, through a construct of interest to nursing, and allows interceptions for the development of instruments that guide nursing activities.
Topics: Aged; Humans; Critical Care; Delirium; Intensive Care Units; Nursing Care; Nursing Theory
PubMed: 38055590
DOI: 10.1590/1518-8345.6707.4070 -
Clinical Interventions in Aging 2023Delirium is common in older patients during the postoperative period, increasing the number of adverse events, and grip strength is associated with delirium....
BACKGROUND
Delirium is common in older patients during the postoperative period, increasing the number of adverse events, and grip strength is associated with delirium. Subsyndromal delirium (SSD) is a prostate of clinical delirium; nevertheless, the relationship between grip strength and SSD has not been elucidated. This study aimed to examine the association between grip strength and SSD in the elderly after arthroplasty.
METHODS
A total of 181 patients were recruited from two Chinese hospitals. SSD and delirium were evaluated before the surgery and the first week after surgery using the confusion assessment method. The Mini-mental State Examination was used to assess patients' cognitive function, and their grip strength was evaluated with an electronic hand dynamometer before surgery. Logistic regression and ROC curve analysis were conducted to determine the odds ratio and predictive value of grip strength for SSD.
RESULTS
The incidence of SSD and postoperative delirium (POD) was 41.44% and 14.36% for the elderly following arthroplasty respectively, and approximately 1/3 of SSD progressed into POD. Older age, declined cognitive function, fall history, and lower grip strength were risk factors for SSD (<0.05). The area under the ROC curve of grip strength was 0.863 and 0.900 for males and females respectively, and the cut-off point of it was determined to be 22.050 kg for men and 18.050 kg for women.
CONCLUSION
SSD and POD are common among older people. Decreased grip strength, advanced age, lower cognitive function, and fall history were independent risk factors for SSD, and grip strength was a significant predictor for SSD in aged patients after the arthroplasty.
Topics: Aged; Female; Humans; Male; Arthroplasty, Replacement; Delirium; Emergence Delirium; Postoperative Complications; Risk Factors; Hand Strength
PubMed: 37810954
DOI: 10.2147/CIA.S423727