Establishment of a Nomogram prediction model for delirium in elderly patients after transurethral resection of the prostate
YUAN Binglin
WANG Derun
LIAO Fuzhi
Abstract：Objective To identify factors that may contribute to postoperative delirium(POD)in elderly patients undergoing transure-thral resection of the prostate(TURP),establish a regression model using appropriate statistical methods,construct a Nomogram predic-tion model,and evaluate the clinical value of this model.Methods A total of 186 elderly patients who underwent TURP in the Urology Department of Zhongshan People's Hospital from June 2018 to June 2022 were selected.By carefully scrutinizing medical records,com-bined with relevant specialist consultations,patients who met the POD diagnosis were classified into the POD group(group A,n=62)and the non-POD group(group B,n=124).Relevant medical record data from both groups were analyzed,and a multivariate Logistic regression model was utilized to identify independent risk factors for POD.Optimal cut-off values were determined through receiver operat-ing characteristic(ROC)curve analysis,and a Nomogram model was constructed using R software.Results (1)Statistically significant differences were observed between the two groups in terms of age,cerebrovascular disease history,hypoxemia,American Society of Anes-thesiologists(ASA)classification,preoperative hemoglobin,albumin,preoperative and postoperative blood glucose levels,postoperative 24-hour score of visual analog scale(VAS),and surgical duration(P＜0.05);(2)According to the analysis of the multivariate Logis-tic regression model,advanced age,large preoperative-to-postoperative blood glucose difference,high ASA classification,high postopera-tive 24-hour VAS score,hypoxemia,and prolonged surgical duration were identified as independent risk factors for POD in elderly patients undergoing TURP.High albumin and high hemoglobin levels could the risk of POD in elderly patients undergoing TURP reduce;(3)The areas under the ROC curve for age,preoperative-to-postoperative blood glucose difference,albumin,hemoglobin,postoperative 24-hour VAS score,surgical duration,intraoperative arterial oxygen partial pressure,hypertension history,cerebrovascular disease history,and preoperative-to-postoperative C-reactive protein difference in TURP patients were 0.767,0.695,0.813,0.831,0.781,0.584,0.615,0.618,0.779,and 0.681,respectively.The optimal cut-off values for age,preoperative-to-postoperative blood glucose difference,albumin,hemoglobin,postoperative 24-hour VAS score,surgical duration,intraoperative arterial oxygen partial pressure,and preopera-tive-to-postoperative C-reactive protein difference were 72 years,4.13 mmol/L,42 g/L,127 g/L,4 points,186 min,80 mmHg,and 2.48 mg/L,respectively;(4)Validation using the modeling data itself showed a C-statistic value of 0.889,indicating high accuracy of the model.Conclusion This study suggests that the scientific Nomogram model,based on variables such as age,preoperative-to-postop-erative blood glucose difference,ASA classification,postoperative 24-hour VAS score,and surgical duration,provides early warning for elderly TURP patients at high risk of POD after transurethral resection of prostate,enabling healthcare providers to take corresponding preventive measures earlier to reduce the incidence of POD.
Keywords：elderly patientstransurethral resection of the prostatepostoperative deliriumNomogram prediction modelrisk factors
Publication Date：2025-06-15
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：6( 196-201 )