Construction of a nomogram model for predicting postoperative delirium in non-hyperlipidemia patients undergoing esophageal cancer resection based on plasma total cholesterol levels
GAO Shengrun
LI Yun
LI Yan
MA Guodong
GAO Chengjie
Abstract：Objective To construct a nomogram model for predicting postoperative delirium(POD)in non-hyperlipidemia patients undergoing esophageal cancer resection based on plasma total cholesterol(TC)levels.Methods A retrospective analysis was conducted on the clinical data of 187 non-hyperlipidemia patients who underwent esophageal cancer resection in the 960th Hospital of the PLA Joint Logistics Support Force from January 2019 to December 2023.According to the occurrence of delirium within 1 week after the operation,the patients were divided into delirium group(24 patients)and non-delirium group(163 patients).Multivariate logistic regression was used to analyze factors influencing the incidence of POD in the patients undergoing esophageal cancer resection,and a nomogram prediction model was constructed.The predictive efficacy of the model was verified by using Hosmer-Lemeshow goodness-of-fit test,Bootstrap resampling method,receiver operating characteristic(ROC)curve and decision curve analysis(DCA).Results Compared with the non-delirium group,the delirium group was older,and had a lower proportion of patients receiving dexmedetomidine treatment,lower levels of intraoperative minimum mean arterial pressure(MAP)and total cholesterol(TC),and low-density lipoprotein cholesterol(LDL-C),longer duration of anesthesia and postoperative hospital stay,and a higher proportion of patients with coronary heart disease,a higher proportion of patients transferred to intensive care unit(ICU)after surgery and a higher proportion of patients who died within 30 days after surgery,with statistically significant differences(P＜0.05).The results of multivariate logistic regression analysis showed that a higher TC level,a higher intraoperative minimum MAP,and use of dexmedetomidine were independent protective factors for inhibiting the incidence of POD in the patients undergoing esophageal cancer resection(P＜0.05).A nomogram prediction model was constructed based on the above three influencing factors.The results of Hosmer-Lemeshow goodness-of-fit test showed that the model fitted well(χ2=3.763,P=0.878).The C-index value obtained by the Bootstrap resampling method was 0.897,indicating that the model had a relatively high prediction consistency.The ROC curve showed that area under the curve(AUC)(95%CI)of the model for predicting POD in patients undergoing esophageal cancer resection was 0.919(0.870-0.969),with specificity of 79.10%and sensitivity of 91.70%.The DCA curve showed that the net benefit of the model was relatively high and stable within the risk thresholds ranging from 0.05 to 0.85,indicating that the model had good clinical value.Conclusion Higher plasma TC level,higher intraoperative minimum MAP and use of dexmedetomidine are independent protective factors for inhibiting the incidence of POD in non-hyperlipidemic patients undergoing esophageal cancer resection.The nomogram prediction model constructed based on the above three factors has good predictive value for POD.
Keywords：Total cholesterolPrediction modelEsophageal cancerPostoperative delirium(POD)The elderlyBlood lipids
Publication Date：2025-10-30
Online Publishing Date：2025-11-13(First online date of this platform, not the publication date of the document)
Pages：6( 1107-1112 )