Yu-Ting Ling, Qian-Qian Guo, Si-Min Wang, Li-Nan Zhang, Jin-Hua Chen, Yi Liu, Ruo-Heng Xuan, Bo Qu, Li-Ge Liu, Zhi-Shuang Wen, Jia-Kun Xu, Lu-Lu Jiang, Wen-Biao Xian, Bin Wu, Chang-Ming Zhang, Ling Chen, Jin-Long Liu, Nan Jiang
{"title":"帕金森病全身麻醉下丘脑下核深部脑刺激术后谵妄的Nomogram预测。","authors":"Yu-Ting Ling, Qian-Qian Guo, Si-Min Wang, Li-Nan Zhang, Jin-Hua Chen, Yi Liu, Ruo-Heng Xuan, Bo Qu, Li-Ge Liu, Zhi-Shuang Wen, Jia-Kun Xu, Lu-Lu Jiang, Wen-Biao Xian, Bin Wu, Chang-Ming Zhang, Ling Chen, Jin-Long Liu, Nan Jiang","doi":"10.1155/2022/6915627","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Postoperative delirium can increase cognitive impairment and mortality in patients with Parkinson's disease. The purpose of this study was to develop and internally validate a clinical prediction model of delirium after deep brain stimulation of the subthalamic nucleus in Parkinson's disease under general anesthesia.</p><p><strong>Methods: </strong>We conducted a retrospective observational cohort study on the data of 240 patients with Parkinson's disease who underwent deep brain stimulation of the subthalamic nucleus under general anesthesia. Demographic characteristics, clinical evaluation, imaging data, laboratory data, and surgical anesthesia information were collected. Multivariate logistic regression was used to develop the prediction model for postoperative delirium.</p><p><strong>Results: </strong>A total of 159 patients were included in the cohort, of which 38 (23.90%) had postoperative delirium. Smoking (OR 4.51, 95% CI 1.56-13.02, <i>p</i> < 0.01) was the most important risk factor; other independent predictors were orthostatic hypotension (OR 3.42, 95% CI 0.90-13.06, <i>p</i>=0.07), inhibitors of type-B monoamine oxidase (OR 3.07, 95% CI 1.17-8.04, <i>p</i>=0.02), preoperative MRI with silent brain ischemia or infarction (OR 2.36, 95% CI 0.90-6.14, <i>p</i>=0.08), Hamilton anxiety scale score (OR 2.12, 95% CI 1.28-3.50, <i>p</i> < 0.01), and apolipoprotein E level in plasma (OR 1.48, 95% CI 0.95-2.29, <i>p</i>=0.08). The area under the receiver operating characteristic curve (AUC) was 0.76 (95% CI 0.66-0.86). A nomogram was established and showed good calibration and clinical predictive capacity. After bootstrap for internal verification, the AUC was 0.74 (95% CI 0.66-0.83).</p><p><strong>Conclusion: </strong>This study provides evidence for the independent inducing factors of delirium after deep brain stimulation of the subthalamic nucleus in Parkinson's disease under general anesthesia. By predicting the development of delirium, our model may identify high-risk groups that can benefit from early or preventive intervention.</p>","PeriodicalId":19907,"journal":{"name":"Parkinson's Disease","volume":"2022 ","pages":"6915627"},"PeriodicalIF":2.1000,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9726266/pdf/","citationCount":"0","resultStr":"{\"title\":\"Nomogram for Prediction of Postoperative Delirium after Deep Brain Stimulation of Subthalamic Nucleus in Parkinson's Disease under General Anesthesia.\",\"authors\":\"Yu-Ting Ling, Qian-Qian Guo, Si-Min Wang, Li-Nan Zhang, Jin-Hua Chen, Yi Liu, Ruo-Heng Xuan, Bo Qu, Li-Ge Liu, Zhi-Shuang Wen, Jia-Kun Xu, Lu-Lu Jiang, Wen-Biao Xian, Bin Wu, Chang-Ming Zhang, Ling Chen, Jin-Long Liu, Nan Jiang\",\"doi\":\"10.1155/2022/6915627\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>Postoperative delirium can increase cognitive impairment and mortality in patients with Parkinson's disease. The purpose of this study was to develop and internally validate a clinical prediction model of delirium after deep brain stimulation of the subthalamic nucleus in Parkinson's disease under general anesthesia.</p><p><strong>Methods: </strong>We conducted a retrospective observational cohort study on the data of 240 patients with Parkinson's disease who underwent deep brain stimulation of the subthalamic nucleus under general anesthesia. Demographic characteristics, clinical evaluation, imaging data, laboratory data, and surgical anesthesia information were collected. Multivariate logistic regression was used to develop the prediction model for postoperative delirium.</p><p><strong>Results: </strong>A total of 159 patients were included in the cohort, of which 38 (23.90%) had postoperative delirium. Smoking (OR 4.51, 95% CI 1.56-13.02, <i>p</i> < 0.01) was the most important risk factor; other independent predictors were orthostatic hypotension (OR 3.42, 95% CI 0.90-13.06, <i>p</i>=0.07), inhibitors of type-B monoamine oxidase (OR 3.07, 95% CI 1.17-8.04, <i>p</i>=0.02), preoperative MRI with silent brain ischemia or infarction (OR 2.36, 95% CI 0.90-6.14, <i>p</i>=0.08), Hamilton anxiety scale score (OR 2.12, 95% CI 1.28-3.50, <i>p</i> < 0.01), and apolipoprotein E level in plasma (OR 1.48, 95% CI 0.95-2.29, <i>p</i>=0.08). The area under the receiver operating characteristic curve (AUC) was 0.76 (95% CI 0.66-0.86). A nomogram was established and showed good calibration and clinical predictive capacity. After bootstrap for internal verification, the AUC was 0.74 (95% CI 0.66-0.83).</p><p><strong>Conclusion: </strong>This study provides evidence for the independent inducing factors of delirium after deep brain stimulation of the subthalamic nucleus in Parkinson's disease under general anesthesia. By predicting the development of delirium, our model may identify high-risk groups that can benefit from early or preventive intervention.</p>\",\"PeriodicalId\":19907,\"journal\":{\"name\":\"Parkinson's Disease\",\"volume\":\"2022 \",\"pages\":\"6915627\"},\"PeriodicalIF\":2.1000,\"publicationDate\":\"2022-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9726266/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Parkinson's Disease\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1155/2022/6915627\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Parkinson's Disease","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1155/2022/6915627","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
摘要
术后谵妄可增加帕金森病患者的认知功能障碍和死亡率。本研究的目的是建立并内部验证帕金森病全身麻醉下丘脑下核深部脑刺激后谵妄的临床预测模型。方法:对240例帕金森病患者在全身麻醉下行丘脑下核深部脑刺激的资料进行回顾性观察队列研究。收集患者的人口学特征、临床评价、影像学资料、实验室资料和手术麻醉信息。采用多因素logistic回归建立术后谵妄预测模型。结果:共纳入159例患者，其中38例(23.90%)出现术后谵妄。吸烟是最重要的危险因素(OR 4.51, 95% CI 1.56 ~ 13.02, p < 0.01);其他独立预测因子为直立性低血压(OR 3.42, 95% CI 0.90-13.06, p=0.07)、b型单胺氧化酶抑制剂(OR 3.07, 95% CI 1.17-8.04, p=0.02)、术前MRI无症状脑缺血或梗死(OR 2.36, 95% CI 0.90-6.14, p=0.08)、汉密尔顿焦虑量表评分(OR 2.12, 95% CI 1.28-3.50, p < 0.01)和血浆载脂蛋白E水平(OR 1.48, 95% CI 0.95-2.29, p=0.08)。受试者工作特征曲线下面积(AUC)为0.76 (95% CI 0.66 ~ 0.86)。建立了nomogram，具有良好的校准和临床预测能力。bootstrap内部验证后，AUC为0.74 (95% CI 0.66-0.83)。结论:本研究为帕金森病全身麻醉下丘脑下核深度脑刺激后谵妄的独立诱发因素提供了证据。通过预测谵妄的发展，我们的模型可以确定高危人群，可以从早期或预防性干预中受益。
Nomogram for Prediction of Postoperative Delirium after Deep Brain Stimulation of Subthalamic Nucleus in Parkinson's Disease under General Anesthesia.
Introduction: Postoperative delirium can increase cognitive impairment and mortality in patients with Parkinson's disease. The purpose of this study was to develop and internally validate a clinical prediction model of delirium after deep brain stimulation of the subthalamic nucleus in Parkinson's disease under general anesthesia.
Methods: We conducted a retrospective observational cohort study on the data of 240 patients with Parkinson's disease who underwent deep brain stimulation of the subthalamic nucleus under general anesthesia. Demographic characteristics, clinical evaluation, imaging data, laboratory data, and surgical anesthesia information were collected. Multivariate logistic regression was used to develop the prediction model for postoperative delirium.
Results: A total of 159 patients were included in the cohort, of which 38 (23.90%) had postoperative delirium. Smoking (OR 4.51, 95% CI 1.56-13.02, p < 0.01) was the most important risk factor; other independent predictors were orthostatic hypotension (OR 3.42, 95% CI 0.90-13.06, p=0.07), inhibitors of type-B monoamine oxidase (OR 3.07, 95% CI 1.17-8.04, p=0.02), preoperative MRI with silent brain ischemia or infarction (OR 2.36, 95% CI 0.90-6.14, p=0.08), Hamilton anxiety scale score (OR 2.12, 95% CI 1.28-3.50, p < 0.01), and apolipoprotein E level in plasma (OR 1.48, 95% CI 0.95-2.29, p=0.08). The area under the receiver operating characteristic curve (AUC) was 0.76 (95% CI 0.66-0.86). A nomogram was established and showed good calibration and clinical predictive capacity. After bootstrap for internal verification, the AUC was 0.74 (95% CI 0.66-0.83).
Conclusion: This study provides evidence for the independent inducing factors of delirium after deep brain stimulation of the subthalamic nucleus in Parkinson's disease under general anesthesia. By predicting the development of delirium, our model may identify high-risk groups that can benefit from early or preventive intervention.
期刊介绍：
Parkinson’s Disease is a peer-reviewed, Open Access journal that publishes original research articles, review articles, and clinical studies related to the epidemiology, etiology, pathogenesis, genetics, cellular, molecular and neurophysiology, as well as the diagnosis and treatment of Parkinson’s disease.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
