Predictive value of preoperative serum MCP-1 and PAI-1 levels combined with fingertip tactile function for postoperative delirium in elderly patients undergoing hip arthroplasty
ZHANG Yunsheng
CHEN Wurong
LYU Juan
JI Chao
Abstract：Objective To investigate the predictive value of preoperative serum monocyte chemotactic protein-1(MCP-1),plasminogen activator inhibitor-1(PAI-1)levels,and fingertip tactile function for postoperative delirium(POD)in elderly patients with hip fractures undergoing hip arthroplasty.Methods A prospective cohort of 220 elderly hip fracture patients undergoing hip arthroplasty was enrolled.Fasting venous blood was collected one day preoperatively.Serum MCP-1 and PAI-1 levels were measured using enzyme-linked immunosorbent assay(ELISA).Concurrently,bilater-al fingertip tactile function was assessed using the Semmes-Weinstein monofilament test.Postoperative delirium was evalu-ated at seven days post-surgery using the Confusion Scale.Clinical perioperative data were compared between elderly hip replacement patients with and without POD.Multivariate Logistic regression analysis identified independent risk factors for POD.Receiver operating characteristic(ROC)curves evaluated the predictive efficacy of preoperative serum MCP-1,pre-operative serum PAI-1,and fingertip tactile function,both individually and in combination,for POD.Internal validation was performed using 1,000 bootstrap resamples,with curve analysis assessing the clinical net benefit of predictive mod-els.Results Among 220 elderly hip replacement patients,45 developed POD,yielding an incidence rate of 20.45%.Elderly patients with POD exhibited higher age,ASA physical status,transfusion rates,intraoperative blood loss,intraop-erative fluid administration,and preoperative serum MCP-1 and PAI-1 levels than those without POD,while albumin lev-els were lower(all P<0.05).Multivariate Logistic regression analysis revealed that increased age,ASA physical status classification Ⅲ-Ⅳ,increased intraoperative fluid administration,elevated preoperative serum MCP-1,elevated preopera-tive serum PAI-1,and worsened fingertip tactile sensation grade were all independent risk factors for POD in elderly hip re-placement patients(all P<0.05).ROC curve analysis revealed that the areas under the curve(AUCs)of preoperative se-rum MCP-1,PAI-1 levels,and fingertip tactile function individually in predicting POD in elderly hip replacement patients were 0.809,0.799,and 0.787,respectively.The combined prediction of POD using all three indicators yielded an AUC of 0.938.Bootstrap internal validation revealed a C-statistic of 0.938(95%CI:0.933-0.943)for the combined model.Decision curve analysis revealed that within the threshold probability range of 0.15 to 0.98,the combined model demon-strated greater net benefit than any single indicator.Conclusions Elevated preoperative serum MCP-1 and PAI-1 lev-els,along with increased fingertip tactile function grading,are independent risk factors for POD in elderly hip replacement patients.The combined use of these three indicators exhibits high predictive value for POD in this patient population.
Keywords：hip fracturehip arthroplastypostoperative deliriummonocyte chemotactic protein-1plasminogen activator inhibitor-1fingertip tactile function
Publication Date：2026-02-25
Online Publishing Date：2026-03-19(First online date of this platform, not the publication date of the document)
Pages：6( 84-89 )