Analysis of risk factors for postoperative delirium after coronary artery bypass grafting and establishment of prediction model

Hu Xiaozhu; Han Qing; Qu Linan; Dong Ran; Li Xuemei

doi:10.3760/j.issn.1673-4777.2024.05.008

Abstract：Objective To investigate the risk factors of postoperative delirium after coronary artery bypass grafting(CABG)and to establish a risk prediction model.Methods The clinical data of 1 067 patients who underwent CABG at Coronary Heart Disease Surgery Center,Beijing Anzhen Hospital,Capital Medical University from January 2022 to June 2023 were retrospectively collected.The intensive care unit(ICU)confusion assessment method(CAM-ICU)was used to assess the occurrence of postoperative delirium.The patients were divided into delirium group and non-delirium group.The clinical characteristics of the two groups were compared.Univariate analysis and multivariate binary Logistic regression analysis were used to determine the independent risk factors affecting the occurrence of delirium,and a nomogram model for predicting the risk of delirium was established.The receiver operating characteristic(ROC)curve was drawn to evaluate the predictive value of the delirium model.Results Among 1 067 patients,there were 133 patients in delirium group,the incidence of delirium was 12.5％,the age was(62±10)years,and 97 cases were male.There were 934 patients in the non-delirium group,the age was(62±9)years and 704 cases were male.SPSS 22.0 software was used to randomly select 747 patients as the experimental group,and the remaining 320 patients were used as the internal validation group.Multivariate Logistic regression analysis showed that education below junior high school,preoperative sleep disorders,history of diabetes mellitus,left ventricular ejection fraction(LVEF)≤45％,mild anemia,hypoproteinemia,cardiopulmonary bypass and ventilator use ≥48 h were independent risk factors for delirium after CABG in the experimental group(all P＜0.05).The ROC analysis showed that the area under the curve(AUC)of the experimental group was 0.736(95％confidence interval:0.682-0.739).The Hosmer-Lemeshow goodness of fit test showed that the risk prediction model had a good goodness of fit,and the P value was 0.748.The AUC of the scoring early warning system was 0.754(95％confidence interval:0.690-0.819).The Hosmer-Lemeshow goodness of fit test showed that the risk prediction model had a good goodness of fit,and the P value was 0.808.Conclusion Delirium is one of the common complications after CABG.Low education level,preoperative sleep disorders,cardiopulmonary bypass and long-term use of ventilator are independent risk factors for delirium after CABG.