老年髋部骨折术后谵妄危险因素分析及预测模型的构建

Risk factors and predictive nomogram of postoperative delirium in elderly patients with hip fractures

摘要

目的 分析重症老年髋部骨折术后谵妄的独立危险因素并建立相应的风险预测模型，以便早期识别高危患者，为临床诊疗提供参考依据加强预防。方法 纳入2023年8月至2024年10月就诊于首都医科大学附属北京积水潭医院老年创伤骨科术后转入重症监护室（intensive care unit ICU）髋部骨折年龄超过65岁的重症老年髋部骨折患者223例（建模组）和2024年11月至2025年1月重症老年髋部骨折患者87例（内部验证组）。使用ICU意识模糊评估量表（CAM-ICU）评估术后谵妄，并进行实验室指标检测。通过单因素和多因素Logistic回归分析确定独立危险因素，并构建列线图模型进行验证。结果 术前谵妄、术后血尿素氮肌酐比≥25.18、年龄校正查尔森合并症指数≥10和入院预后营养指数<41.53为老年髋部骨折术后谵妄的独立危险因素。构建的预测模型AUC为0.69，敏感性为64.7%，特异性为67.1%，显示出较好的区分度和校准度。结论 本研究分析了重症老年髋部骨折患者术后谵妄的独立危险因素，并建立了有效的预测模型。

Abstract

Objective To analyze independent risk factors of postoperative delirium (POD) in critically ill elderly patients with hip fractures and establish a prediction model for early identification of high-risk patients, and provide a reference for clinical diagnosis and treatment. Methods This study enrolled 223 critically ill patients aged >65 years undergone hip fracture surgery in the Department of Intensive Care Unit, as the modeling cohort from August 2023 to October 2024 from Department of Orthopaedic Trauma, Beijing Jishuitan Hospital, Capital Medical University and 87 patients for external validation from November 2024 to January 2025 in Department of Intensive Care Unit. The confusion assessment method for the intensive care unit (CAM-ICU) was used to diagnose postoperative delirium. Univariate and multivariate Logistic regression analyses identified independent risk factors, and a nomogram prediction model was developed and validated. Results Preoperative delirium, postoperative blood urea nitrogen-to-creatinine ratio ≥25.18, age-adjusted Charlson comorbidity index ≥10, and admission prognostic nutritional index <41.53 were identified as independent risk factors for postoperative delirium. The prediction model demonstrated an AUC of 0.69, sensitivity of 64.7%, and specificity of 67.1%, indicating good discrimination and calibration. Conclusion Independent risk factors for POD in critically ill elderly hip fracture patients were established, and an effective prediction model was developed.

关键词

髋骨折 / 老年人 / 谵妄 / 危险因素 / 预测模型

Key words

Hip fractures / Eged / Delirium / Risk factors / Prediction model

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基金资助

2023年国家临床重点专科建设项目()

首都医科大学附属北京积水潭医院青年基金(QN202304)