Glucose to Albumin Ratio as a New Predictive Indicator for Postoperative Delirium in Geriatric Hip Fracture Patients.

Abstract

Background: Predicting postoperative delirium (POD) in patients who have hip fractures is challenging due to its complex mechanism. Therefore, there is a critical need to explore and evaluate a novel predictive indicator.

Methods: There were four hematological markers independently associated with POD that were utilized to construct and evaluate a more reliable predictive indicator for POD. The study employed random sampling, dividing the data into training and validation cohorts in a 7:3 ratio. The strength of association between each predictive indicator and POD was assessed using multivariable logistic analysis and propensity score matching analysis (PSM). Predictive indicators with significant correlations underwent receiver operating characteristic curve (ROC) and characteristic parameter comparisons to identify the optimal predictive indicator. Subsequent validation included the assessment of discriminative ability, correlation, and predictive performance. Furthermore, subgroup analysis was conducted to explore potential interactions.

Results: A total of 1,807 patients were included in this study, with a POD incidence rate of 16.5%. Multivariable logistic analysis and PSM analysis demonstrated that the glucose-to-albumin ratio (GAR) was independently positively associated with POD. Specifically, for every 0.1-unit increase in preoperative GAR levels in hip fracture patients, the risk of POD increased by 1.6 times. The ROC curve indicated that the optimal cut-off value for the GAR was 0.2, with an area under the curve (AUC) of 0.8, sensitivity of 81.2%, and specificity of 59.0%.

Conclusions: Preoperative GAR has a certain predictive value for the occurrence of POD and can function as a novel indicator for predicting POD in geriatric hip fracture patients.