术后谵妄国际术前风险评估模型的建立与验证

以下文章来源于小麻哥的日常 ，作者两只小绵羊

摘要译文（供参考）  

术后谵妄国际术前风险评估模型的建立与验证  

背景：  

术后谵妄（postoperative delirium，POD）是老年人的常见并发症，其特征是注意力、意识和认知障碍，并与长期住院、功能恢复差、认知能力下降、长期痴呆和死亡率增加有关。早期识别有POD风险的患者可以大大有助于预防。  

方法：  

我们利用系统综述中确定的八项研究的数据，并提供个体水平的数据，开发了一种术前POD风险预测算法。使用十倍交叉验证法对最终惩罚逻辑回归模型的预测因子进行筛选和的内部验证。使用瑞士和德国大学医院的数据进行外部验证。  

结果：  

模型建立包括2250名60岁或以上的外科患者（不包括心脏和颅内手术患者），其中444人发展为POD。最终模型包括年龄、体重指数、美国麻醉师协会（ASA）评分、谵妄病史、认知障碍、药物、随机C反应蛋白（CRP）、手术风险以及手术是否为剖腹手术/开胸手术。在内部验证时，该算法在有CRP的情况下的AUC为0.80（95%置信区间：0.77-0.82），在无CRP情况下的AUC为0.79（95%可信区间：0.77-2.82）。外部验证包括359名患者，其中87人出现POD。外部验证的AUC为0.74（95%置信区间：0.68-0.80）。  

结论：

该算法名为PIPRA（Pre-Interventional Preventive Risk Assessment，干预前预防性风险评估），具有欧洲一致性（ce，European conformity）认证。它可用于优化患者护理，优先考虑易感患者的干预措施，并为在临床实践中实施POD预防策略提供了一种有效的方法。  

关键词：

算法；临床实践；老年人；术后谵妄；风险预测。  

Development and validation of an international preoperative risk assessment model for postoperative delirium Background: Postoperative delirium (POD) is a frequent complication in older adults, characterised by disturbances in attention, awareness and cognition, and associated with prolonged hospitalisation, poor functional recovery, cognitive decline, long-term dementia and increased mortality. Early identification of patients at risk of POD can considerably aid prevention. 

Methods: We have developed a preoperative POD risk prediction algorithm using data from eight studies identified during a systematic review and providing individual-level data. Ten-fold cross-validation was used for predictor selection and internal validation of the final penalised logistic regression model. The external validation used data from university hospitals in Switzerland and Germany. 

Results: Development included 2,250 surgical (excluding cardiac and intracranial) patients 60 years of age or older, 444 of whom developed POD. The final model included age, body mass index, American Society of Anaesthesiologists (ASA) score, history of delirium, cognitive impairment, medications, optional C-reactive protein (CRP), surgical risk and whether the operation is a laparotomy/thoracotomy. At internal validation, the algorithm had an AUC of 0.80 (95% CI: 0.77-0.82) with CRP and 0.79 (95% CI: 0.77-0.82) without CRP. The external validation consisted of 359 patients, 87 of whom developed POD. The external validation yielded an AUC of 0.74 (95% CI: 0.68-0.80). 

Conclusions: The algorithm is named PIPRA (Pre-Interventional Preventive Risk Assessment), has European conformity (ce) certification, is available at http://pipra.ch/ and is accepted for clinical use. It can be used to optimise patient care and prioritise interventions for vulnerable patients and presents an effective way to implement POD prevention strategies in clinical practice. 

Keywords: algorithm; clinical practice; older people; postoperative delirium; risk prediction 

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本公众平台所刊载原创或转载内容不代表米勒之声的观点或立场。文中所涉及药物使用、疾病诊疗等内容仅供医学专业人士参考。

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编辑：MiSuper.米超

校对：Michel.米萱  

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