术前肾小球滤过率低伴随老年患者术后谵妄风险增加:对随机对照研究数据的二次分析

Low preoperative glomerular filtration rate is associated with an increased risk of postoperative delirium in elderly patients: a secondary analysis of a randomized controlled study

目的评估术前肾小球滤过率与老年危重患者术后谵妄发生风险的关系。方法此研究是对前期一项随机对照研究700例非心脏手术后收住ICU老年患者资料的二次分析。根据慢性肾脏疾病流行病合作工作组公式计算术前肾小球滤过率估算值(estimated glomerular filtration rate, eGFR)。术后前7 d采用ICU意识模糊评估法(Confusion Assessment Method for the Intensive Care Unit, CAM-ICU)每日2次评估谵妄发生情况。采用单因素Logistic回归分析筛选与术后谵妄发生可能相关的因素;将P<0.05的因素纳入多因素Logistic回归模型,分析校正混杂因素后术前eGFR与术后谵妄的关系。结果全部700例患者术前eGFR中位数为72.0 ml·min^-11.73m^-2.低eGFR(<72.0ml·min^-1 1.73m^-2)患者术后谵妄发生率高于高eGFR(≥1.73m^-2)患者(19。1%比12.6%,P=0.017)。校正混杂因素后,术前eGFR高者术后谵妄发生风险降低[比值比(odds ratio, OR)=0.990, 95%CI 0.980~1.000, P=0.041],术前eGFR<72.0 ml·min-1·1.73m^-2是术后谵妄的独立危险因素(OR=1.796,95%CI 1.157~2.789,P=0.009)。结论对于非心脏手术后收住ICU的老年患者,术前低eGFR伴随术后谵妄风险增加。

Objective To evaluate the association between preoperative estimated glomerular filtration rate and the risk of postoperative delirium in elderly patients. Methods The current study was a secondary analysis based on data from a randomized controlled study where 700 elderly patients were admitted to the intensive care unit (ICU) after noncardiac surgery. The preoperative estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration equation. Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) was used to evaluate the occurrence of delirium twice a day in the first 7 d after surgery. Univariate Logistic regression analyses were performed to identify potential factors associated with the development of postoperative delirium, and factors with P<0.05 were included in a multivariate Logistic regression model to analyze the risk adjusted association between preoperative eGFR and postoperative delirium. Results The median of preoperative eGFR of all enrolled 700 patients was 72.0 ml·min-1·1.73m-2. The incidence of postoperative delirium was higher in patients with low preoperative eGFR (<72.0 ml·min-1·1.73m-2) than those with high preoperative eGFR (≥72.0 ml·min-1·1.73m-2)(19.1% vs. 12.6%, P=0.017). After correction for confounding factors, higher preoperative eGFR was associated with a lower risk of postoperative delirium (OR=0.990, 95%CI 0.980-1.000, P=0.041), a preoperative eGFR <72.0 ml·min-1·1.73 m-2 was an independent risk factor of postoperative delirium (OR=1.796, 95%CI 1.157-2.789, P=0.009). Conclusions For elderly patients admitted to ICU after noncardiac surgery, a low preoperative eGFR is associated with an increased risk of postoperative delirium.