Abstract：
Patients undergoing coronary artery bypass graft (CABG) are at high risk for developing postoperative delirium (POD). A simple prediction rule may benefit patients from early identification of POD followed by adequate preventive strategies. The purpose of the current study was to develop and validate a POD prediction rule for patients undergoing CABG (POD-CABG), by considering all possible perioperative factors.
In this prospective cohort study, patients who underwent first elective isolated CABG were continuously enrolled from May 2014 to November 2015 in a tertiary hospital. Delirium was assessed using the Confusion Assessment Method for Intensive Care Unit. Patients\' perioperative risk factors were collected through interviews and review of medical records. The area under receiver-operating characteristic curve (AUC) was used to assess the overall performance of the predictive rule.
A total of 242 and 148 patients were enrolled in the derivation and validation cohorts, respectively. Multiple logistic regression analysis identified seven variables that were independently associated with POD: age (≥65 years), gender (female), history of myocardial infarction and diabetes mellitus, postoperative atrial fibrillation, the use of intra-aortic balloon pump, and serum interleukin-6 ≥478 pg/ml at 18 hours after surgery. The AUC of the POD-CABG was 0.84 (95% CI, 0.79-0.90) in the derivation cohort, and was 0.86 (95% CI, 0.80-0.91) after bootstrap resampling. The AUC was 0.81 (95% CI, 0.73-0.88) after the POD-CABG was applied to the validation cohort.
The POD-CABG with inclusion of interleukin-6 demonstrated good performance in predicting POD.
In this prospective cohort study, patients who underwent first elective isolated CABG were continuously enrolled from May 2014 to November 2015 in a tertiary hospital. Delirium was assessed using the Confusion Assessment Method for Intensive Care Unit. Patients\' perioperative risk factors were collected through interviews and review of medical records. The area under receiver-operating characteristic curve (AUC) was used to assess the overall performance of the predictive rule.
A total of 242 and 148 patients were enrolled in the derivation and validation cohorts, respectively. Multiple logistic regression analysis identified seven variables that were independently associated with POD: age (≥65 years), gender (female), history of myocardial infarction and diabetes mellitus, postoperative atrial fibrillation, the use of intra-aortic balloon pump, and serum interleukin-6 ≥478 pg/ml at 18 hours after surgery. The AUC of the POD-CABG was 0.84 (95% CI, 0.79-0.90) in the derivation cohort, and was 0.86 (95% CI, 0.80-0.91) after bootstrap resampling. The AUC was 0.81 (95% CI, 0.73-0.88) after the POD-CABG was applied to the validation cohort.
The POD-CABG with inclusion of interleukin-6 demonstrated good performance in predicting POD.
摘要：
接受冠状动脉旁路移植术（CABG）的患者发生术后谵妄（POD）的风险很高。简单的预测规则可能会使患者从早期识别POD中受益，然后采取适当的预防策略。本研究的目的是开发和验证接受CABG（POD-CABG）的患者的POD预测规则，通过考虑所有可能的围手术期因素。
在这项前瞻性队列研究中，从2014年5月至2015年11月,我们在一家三级医院连续纳入了首次选择性分离CABG的患者.使用重症监护病房的混乱评估方法评估谵妄。通过访谈和病历回顾收集患者围手术期危险因素。使用接受者工作特征曲线下面积（AUC）来评估预测规则的总体性能。
共有242和148名患者被纳入推导和验证队列，分别。多元逻辑回归分析确定了与POD独立相关的七个变量：年龄（≥65岁），性别(女性),心肌梗死和糖尿病病史，术后心房颤动,使用主动脉内球囊泵，术后18小时血清白细胞介素-6≥478pg/ml。衍生队列中POD-CABG的AUC为0.84(95%CI,0.79-0.90),自举重新采样后为0.86（95%CI，0.80-0.91）。将POD-CABG应用于验证队列后，AUC为0.81（95％CI，0.73-0.88）。
包含白介素-6的POD-CABG在预测POD方面表现良好。
在这项前瞻性队列研究中，从2014年5月至2015年11月,我们在一家三级医院连续纳入了首次选择性分离CABG的患者.使用重症监护病房的混乱评估方法评估谵妄。通过访谈和病历回顾收集患者围手术期危险因素。使用接受者工作特征曲线下面积（AUC）来评估预测规则的总体性能。
共有242和148名患者被纳入推导和验证队列，分别。多元逻辑回归分析确定了与POD独立相关的七个变量：年龄（≥65岁），性别(女性),心肌梗死和糖尿病病史，术后心房颤动,使用主动脉内球囊泵，术后18小时血清白细胞介素-6≥478pg/ml。衍生队列中POD-CABG的AUC为0.84(95%CI,0.79-0.90),自举重新采样后为0.86（95%CI，0.80-0.91）。将POD-CABG应用于验证队列后，AUC为0.81（95％CI，0.73-0.88）。
包含白介素-6的POD-CABG在预测POD方面表现良好。
