Delirium in Mechanically Ventilated Patients After Cardiac Surgery: The Importance of Preoperative Nutritional Management Revealed by a Multicenter Retrospective Cohort Study

IF 3.5 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of Evidence‐Based Medicine Pub Date : 2025-06-06 DOI:10.1111/jebm.70042

Liang Hong, Jiawen Wang, Tianling Feng, Hongwei Fan, Xiao Shen, Wenxiu Chen, Hong Tao, Weifeng Yao, Jianjun Zou, Min Yang

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引用次数: 0

Abstract

Objective

The effects of malnutrition on postoperative delirium (POD) after cardiac surgery remains understudied. We hypothesized that preoperative prognostic nutrition index (PNI) has a significant clinical role in predicting POD among mechanically ventilated patients undergoing cardiac surgery.

Methods

We conducted a multicenter retrospective study of adult patients who underwent cardiac surgery and subsequently received mechanical ventilation (MV) in the Intensive Care Unit at Nanjing First Hospital (NFH-ICU) and from Medical Information Mart for Intensive Care IV (MIMIC-IV). The relationship between PNI and POD was examined by Cox proportional hazards models, propensity score matching, mediation analysis, subgroup analysis, and sensitivity analysis.

Results

2725 participants of NFH-ICU and 3368 participants of MIMIC-IV were included in this study. Reduced PNI levels were identified as an independent risk factor for POD, and its addition enhanced the accuracy of predicting POD. After adjusting for all confounders, Cox analysis revealed that PNI≤45.5 was significantly associated with the risk of progressing to POD (NFH-ICU: HR = 1.46, 95% CI 1.01–2.11, p = 0.044; MIMIC-IV: HR = 1.53, 95% CI 1.14–2.07, p = 0.005). We also analyzed the mediating role of duration of MV on malnutrition and POD. The proportions mediated were 31.64% and 9.71% in NFH-ICU and MIMIC-IV, respectively.

Conclusion

The decreased PNI can increase the risk of POD after cardiac surgery. Meanwhile, the increased risk of POD associated with low PNI was partially mediated by prolonged duration of MV after surgery. The study highlights the preoperative nutritional management as an important intervention to prevent postoperative delirium in patients undergoing cardiac surgery.

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心脏手术后机械通气患者谵妄：一项多中心回顾性队列研究显示术前营养管理的重要性

目的营养不良对心脏术后谵妄（POD）的影响尚不清楚。我们假设术前预后营养指数（PNI）在预测机械通气心脏手术患者POD方面具有重要的临床作用。方法对南京第一医院重症监护病房（NFH-ICU）和重症监护医学信息市场（MIMIC-IV）接受心脏手术并随后接受机械通气（MV）的成年患者进行多中心回顾性研究。采用Cox比例风险模型、倾向评分匹配、中介分析、亚组分析和敏感性分析检验PNI与POD的关系。结果共纳入2725例NFH-ICU患者和3368例MIMIC-IV患者。PNI水平降低被确定为POD的独立危险因素，其增加可提高POD预测的准确性。校正所有混杂因素后，Cox分析显示PNI≤45.5与进展为POD的风险显著相关(NFH-ICU: HR = 1.46, 95% CI 1.01-2.11, p = 0.044；MIMIC-IV: HR = 1.53, 95% CI 1.14-2.07, p = 0.005)。我们还分析了MV持续时间对营养不良和POD的中介作用。NFH-ICU和MIMIC-IV中介导的比例分别为31.64%和9.71%。结论PNI降低可增加心脏手术后发生POD的风险。同时，术后MV持续时间延长部分介导了低PNI相关POD风险的增加。本研究强调术前营养管理是预防心脏手术患者术后谵妄的重要干预措施。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Evidence‐Based Medicine MEDICINE, GENERAL & INTERNAL-

CiteScore

11.20

自引率

1.40%

发文量

期刊介绍： The Journal of Evidence-Based Medicine (EMB) is an esteemed international healthcare and medical decision-making journal, dedicated to publishing groundbreaking research outcomes in evidence-based decision-making, research, practice, and education. Serving as the official English-language journal of the Cochrane China Centre and West China Hospital of Sichuan University, we eagerly welcome editorials, commentaries, and systematic reviews encompassing various topics such as clinical trials, policy, drug and patient safety, education, and knowledge translation.