Developing a Nomogram to Predict the Risk of Delirium in ICU Patients: A Retrospective Cohort Study.

IF 2 4区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Risk Management and Healthcare Policy Pub Date : 2025-09-24 eCollection Date: 2025-01-01 DOI:10.2147/RMHP.S541256

Dongdong Chen, Xinxia Yang

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引用次数: 0

Abstract

Background: Delirium is a prevalent and severe neuropsychiatric syndrome commonly observed among critically ill patients in the intensive care unit (ICU). Despite its substantial clinical impact, effective tools for predicting delirium risk remain limited. This study aimed to develop and validate a nomogram to predict the risk of delirium in ICU patients, integrating clinical, demographic and laboratory parameters for individualized risk assessment.

Methods: A retrospective cohort study was conducted involving 964 ICU patients admitted between January 2020 and December 2023. Comprehensive clinical data were collected, and delirium was assessed using the Confusion Assessment Method for the ICU (CAM-ICU). Predictive variables were identified using Least Absolute Shrinkage and Selection Operator (LASSO) regression, followed by multivariate logistic regression analysis. A nomogram was constructed based on significant predictors and validated using calibration curves, receiver operating characteristic (ROC) curves, and decision curve analysis (DCA).

Results: Among the 964 ICU patients, 186 (19.3%) developed delirium. Eight predictors were identified as independent risk factors for delirium, including drug abuse, alcohol abuse, male sex, maximum potassium (potassium_max), minimum chloride (chloride_min), length of hospital stay, maximum blood urea nitrogen (BUN_max), and minimum hematocrit (hematocrit_min). The nomogram demonstrated good discrimination with an area under the ROC curve (AUC) of 0.732 (95% CI: 0.690-0.773) and satisfactory calibration. DCA confirmed the clinical utility of the model, showing a net benefit across a wide range of risk thresholds.

Conclusion: This study developed a robust and clinically applicable nomogram for predicting ICU delirium risk, integrating key clinical and laboratory variables. The nomogram can aid ICU clinicians in implementing timely preventive interventions to improve patient outcomes.

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建立一种预测ICU患者谵妄风险的Nomogram：一项回顾性队列研究。

背景：谵妄是重症监护病房（ICU）危重患者中常见的一种严重的神经精神综合征。尽管它具有重大的临床影响，但预测谵妄风险的有效工具仍然有限。本研究旨在开发并验证一种预测ICU患者谵妄风险的nomogram，整合临床、人口学和实验室参数进行个体化风险评估。方法：对2020年1月至2023年12月住院的964例ICU患者进行回顾性队列研究。收集综合临床资料，采用ICU神志不清评定法（CAM-ICU）对谵妄进行评定。使用最小绝对收缩和选择算子（LASSO）回归确定预测变量，然后进行多变量逻辑回归分析。基于显著性预测因子构建nomogram，并通过校准曲线、受试者工作特征（ROC）曲线和决策曲线分析（DCA）进行验证。结果：964例ICU患者中出现谵妄186例（19.3%）。8个预测因素被确定为谵妄的独立危险因素，包括药物滥用、酒精滥用、男性、最大钾（钾）、最小氯（氯）、住院时间、最大尿素氮（BUN_max）和最小红细胞压积（hematocrit_min）。该nomogram具有良好的判别能力，ROC曲线下面积（AUC）为0.732 (95% CI: 0.690-0.773)，校正结果令人满意。DCA证实了该模型的临床效用，显示出在广泛的风险阈值范围内的净收益。结论：本研究综合了关键的临床和实验室变量，建立了一种可靠且临床适用的预测ICU谵妄风险的nomogram。图可以帮助ICU临床医生实施及时的预防干预措施，以改善患者的预后。

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来源期刊

Risk Management and Healthcare Policy Medicine-Public Health, Environmental and Occupational Health

CiteScore

6.20

自引率

2.90%

发文量

242

审稿时长

16 weeks

期刊介绍： Risk Management and Healthcare Policy is an international, peer-reviewed, open access journal focusing on all aspects of public health, policy and preventative measures to promote good health and improve morbidity and mortality in the population. Specific topics covered in the journal include: Public and community health Policy and law Preventative and predictive healthcare Risk and hazard management Epidemiology, detection and screening Lifestyle and diet modification Vaccination and disease transmission/modification programs Health and safety and occupational health Healthcare services provision Health literacy and education Advertising and promotion of health issues Health economic evaluations and resource management Risk Management and Healthcare Policy focuses on human interventional and observational research. The journal welcomes submitted papers covering original research, clinical and epidemiological studies, reviews and evaluations, guidelines, expert opinion and commentary, and extended reports. Case reports will only be considered if they make a valuable and original contribution to the literature. The journal does not accept study protocols, animal-based or cell line-based studies.