Preoperative Prognostic Nutritional Index as a Useful Tool for Predicting Postoperative Delirium in Elderly Patients with Degenerative Lumbar Diseases.

IF 2.8 3区医学 Q1 Pharmacology, Toxicology and Pharmaceutics

Therapeutics and Clinical Risk Management Pub Date : 2025-06-07 eCollection Date: 2025-01-01 DOI:10.2147/TCRM.S520912

Jinlei Zhou, Jing Tang, Shanggao Xie, Haiyu Shao, Chen Xia, Yazeng Huang, Tingxiao Zhao

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Abstract

Purpose: The high incidence of postoperative delirium (POD) among patients undergoing lumbar spine surgery presents a significant barrier to achieving enhanced postoperative recovery. Accordingly, a thorough understanding and precise identification of common risk factors for POD in this surgical context are crucial to mitigating its occurrence and facilitating improved recovery outcomes. This study is the first to assess the predictive value of the Prognostic Nutritional Index (PNI) for POD in elderly patients undergoing transforaminal lumbar interbody fusion (TLIF) for degenerative lumbar spine disease.

Methods: We conducted a retrospective analysis of the outcomes of TLIF surgery in elderly patients with degenerative lumbar spine disease between 2020 and 2024. The diagnosis of POD was based on postoperative medical records during hospitalization, using the Confusion Assessment Method. The PNI was calculated based on preoperative serum albumin levels and total lymphocyte counts. Multivariate logistic regression analysis was performed to evaluate the relationship between preoperative PNI scores and the occurrence of POD. Finally, the optimal PNI cut-off point for predicting POD was determined using the receiver operating characteristic curve.

Results: POD was observed in 61 of 370 patients, with PNI being significantly lower in the delirium group. The mean PNI values were 43.02±3.44 in the non-delirium group and 48.53±3.72 in the delirium group. Multivariate logistic regression analysis revealed that low PNI (OR: 0.743; 95% CI: 0.597-0.924; p = 0.008), low serum albumin levels (OR: 0.759; 95% CI: 0.584-0.987; p = 0.040), and advanced age (OR: 1.096; 95% CI: 1.030-1.166; p = 0.004) were independent predictors of POD following TLIF. The area under the curve (AUC) for PNI on the receiver operating characteristic curve was 0.864±0.025. The cutoff value for PNI, determined using the Youden index, was 45.825, with a sensitivity of 82.0% and a specificity of 74.4%.

Conclusion: The preoperative use of PNI holds promise as a valuable tool for assessing the risk of POD in elderly patients undergoing TLIF.

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术前预后营养指数作为预测老年退行性腰椎疾病患者术后谵妄的有用工具。

目的：腰椎手术患者术后谵妄（POD）的高发生率是提高术后恢复的重要障碍。因此，全面了解和准确识别手术环境下POD的常见危险因素对于减少其发生和促进改善恢复结果至关重要。这项研究首次评估了预后营养指数（PNI）对行椎间孔腰椎椎间融合术治疗退行性腰椎疾病的老年患者POD的预测价值。方法：回顾性分析2020年至2024年间老年退行性腰椎疾病患者行TLIF手术的结果。POD的诊断基于住院期间的术后病历，采用混淆评估法。PNI是根据术前血清白蛋白水平和总淋巴细胞计数计算的。采用多因素logistic回归分析术前PNI评分与POD发生的关系。最后，利用受试者工作特性曲线确定预测POD的最佳PNI截止点。结果：370例患者中有61例出现POD，谵妄组PNI明显降低。非谵妄组PNI平均值为43.02±3.44，谵妄组为48.53±3.72。多因素logistic回归分析显示，低PNI (OR: 0.743；95% ci: 0.597-0.924；p = 0.008)，低血清白蛋白水平(OR: 0.759；95% ci: 0.584-0.987；p = 0.040)，高龄(OR: 1.096；95% ci: 1.030-1.166；p = 0.004)是TLIF后POD的独立预测因子。PNI在受试者工作特征曲线上的曲线下面积（AUC）为0.864±0.025。使用约登指数确定PNI的临界值为45.825，敏感性为82.0%，特异性为74.4%。结论：术前使用PNI有望作为评估老年TLIF患者POD风险的有价值的工具。

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

Therapeutics and Clinical Risk Management HEALTH CARE SCIENCES & SERVICES-

CiteScore

5.30

自引率

3.60%

发文量

139

审稿时长

16 weeks

期刊介绍： Therapeutics and Clinical Risk Management is an international, peer-reviewed journal of clinical therapeutics and risk management, focusing on concise rapid reporting of clinical studies in all therapeutic areas, outcomes, safety, and programs for the effective, safe, and sustained use of medicines, therapeutic and surgical interventions in all clinical areas. The journal welcomes submissions covering original research, clinical and epidemiological studies, reviews, guidelines, expert opinion and commentary. The journal will consider case reports but only if they make a valuable and original contribution to the literature. As of 18th March 2019, Therapeutics and Clinical Risk Management will no longer consider meta-analyses for publication. The journal does not accept study protocols, animal-based or cell line-based studies.