术前C-反应蛋白与白蛋白比值对老年股骨转子间骨折患者围手术期谵妄的预测作用

Predictive effect of the preoperative ratio of C reactive protein to albumin on perioperative delirium in geriatric patients with femoral intertrochanteric fracture

目的探讨老年股骨转子间骨折患者术前血清C-反应蛋白与白蛋白比值(CAR)对围手术期发生谵妄的预测作用。方法回顾性分析2013年1月至2016年3月期间首都医科大学宣武医院骨科收治的398例股骨转子间骨折患者资料。根据患者围手术期是否出现谵妄分为2组:谵妄组(n=57)和非谵妄组(n=341),比较两组患者的性别、年龄、体重指数、血常规、CAR、生化指标、凝血指标及合并内科疾病情况等一般资料。先将患者一般资料进行单因素logistic回归分析,再将P<0.10的因素导入多因素logistic二元回归分析模型,筛选出老年股骨转子间骨折患者围手术期谵妄的危险因素;绘制受试者工作特征(ROC)曲线,分析CAR对老年股骨转子间骨折患者围手术期出现谵妄的预测价值和最佳临界点。结果本组患者术后谵妄发生率为14.32%(57/398)。谵妄组患者的年龄、C-反应蛋白、CAR、血小板及合并肺部感染的概率显著高于非谵妄组患者,而血红蛋白、白蛋白、前白蛋白显著低于非谵妄组患者,差异均有统计学意义(P<0.05)。多因素logistic二元回归分析结果显示:血红蛋白(OR=0.975,95%CI:0.957~0.993,P=0.006)和CAR(OR=53.713,95%CI:17.713~162.876,P<0.001)是老年股骨转子间骨折患者围手术期谵妄的危险因素。CAR在预测老年股骨转子间骨折患者围手术期谵妄的ROC曲线下面积为0.906(95%CI:0.873~0.933,P<0.001),对应CAR的最佳临界点为2.06。当CAR>2.06时,谵妄的预测发生率为50.50%,对应敏感度为89.47%,特异度为85.34%。结论CAR是老年股骨转子间骨折患者围手术期谵妄的危险因素,可作为预测谵妄发生的有效指标。

Objective To explore the clinical predictive effect of the preoperative ratio of C reactive protein to albumin(CAR)on perioperative delirium(POD)in geriatric patients with femoral intertrochanteric fracture.Methods The clinical data were analyzed retrospectively of the 398 patients who had undergone surgery for femoral intertrochanteric fractures at Department of Orthopedics,Xuanwu Hospital from January 2013 to March 2016.According to the presence or absence of POD,all the patients were divided into 2 groups:a delirium group and a normal group.The 2 groups were compared in terms of general clinical data like gender,age,body mass index,blood routine,CAR,biochemical indicators,blood coagulation indicators and concomitant internal diseases.After a single factor logistic regression analysis of the general clinical data of the patients,factors with P<0.10 were introduced into the multivariate logistic binary regression model to screen out the risk factors for POD in geriatric patients with femoral intertrochanteric fracture.The receiver operating characteristic(ROC)curve was drawn to analyze the predictive value and optimal cut-off point of CAR for POD in geriatric patients with femoral intertrochanteric fracture.Results The incidence of POD in this cohort was 14.32%(57/398).The age,C-reactive protein,CAR,platelet and probability of pulmonary infection in the delirium group were significantly higher than those in the normal group,but the hemoglobin,albumin and prealbumin in the former were significantly lower than those in the latter(P<0.05).The multivariate logistic binary regression analysis showed that hemoglobin(OR=0.975,95%CI:0.957 to 0.993,P=0.006)and CAR(OR=53.713,95%CI:17.713 to 162.876,P<0.001)were risk factors for POD in geriatric patients with femoral intertrochanteric fracture.The area under ROC of CAR in predicting POD in geriatric patients with femoral intertrochanteric fracture was 0.906(95%CI:0.873 to 0.933,P<0.001),and the cut-off point was 2.06.When CAR>2.06,its predicted incidence of POD was 50.50%,with a sensitivity of 89.47%and a specificity of 85.34%.Conclusion As CAR is a risk factor for POD in geriatric patients with femoral intertrochanteric fracture,it can be used as an effective indicator to predict POD.