系统免疫炎症营养指数对老年腹腔镜前列腺癌根治术患者术后谵妄的预测价值

Predictive value of systemic immune⁃inflammatory⁃nutritional index for postoperative delirium in elderly patients underwent laparoscopic radical prostatectomy

目的 探讨术前系统免疫炎症营养指数(SIINI)评价对老年腹腔镜下前列腺癌根治术(LRP)患者并发术后谵妄(POD)的预测价值。方法 选取2019年1月至2022年12月在海南医学院第二附属医院行LRP的657例老年患者作为研究对象。采用受试者工作特征(ROC)曲线分析术前SIINI评价对老年LRP患者并发POD的预测价值。采用单因素分析和多因素Logistic回归分析探讨术前SIINI与老年LRP患者并发POD的关系,并构建和评价基于术前SIINI的列线图预测模型。结果 老年LRP患者POD的发生率为16.59%(109/657)。经ROC曲线分析,术前SIINI预测老年LRP患者并发POD的效能高于中性粒细胞/淋巴细胞比值和预后营养指数。Logistic回归分析结果显示,年龄≥75岁、简易精神状态检查量表评分<27分、手术时间≥120 min、术中出血量≥600 mL、SIINI≥18.51是老年LRP患者并发POD的独立危险因素(P<0.05)。基于术前SIINI构建的列线图预测模型的一致性指数为0.895(95%CI:0.858~0.932),校准曲线斜率接近1,具有较高的净获益率。结论 术前SIINI值升高提示老年LRP患者并发POD风险,基于术前SIINI构建的列线图模型具有较高的预测价值和临床实用性。

Objective To investigate the predictive value of preoperative systemic immune⁃inflammatory⁃nutritional index(SIINI)for concurrent postoperative delirium(POD)in elderly patients underwent laparoscopic radical prostatectomy(LRP).Methods A total of 657 elderly patients underwent LRP in the Second Affiliated Hospital of Hainan Medical University from January 2019 to December 2022 were selected as the study subjects.The receiver operating characteristic(ROC)curves analysis was used to evaluate the predictive value of preoperative SIINI for concurrent POD in elderly patients underwent LRP.Univariate analysis and multivariate Logistic regression analysis were used to investigate the relationship between preoperative SIINI and concurrent POD in elderly patients underwent LRP,and a nomogram based on preoperative SIINI to predict concurrent POD in elderly patients underwent LRP was established and evaluated.Results The incidence rate of POD in elderly patients underwent LRP was 16.59%(109/657).According to ROC curve analysis,the efficiency of preoperative SIINI for predicting concurrent POD in elderly patients underwent LRP was higher than neutrophil⁃to⁃lymphocyte ratio and prognostic nutritional index.Logistic regression analysis showed that age≥75 years,mini⁃mental state examination score<27 points,operation time≥120 min,intraoperative blood loss≥600 mL and SIINI≥18.51 were independent risk factors for concurrent POD in elderly patients underwent LRP(P<0.05).A nomogram prediction model was established based on preoperative SIINI,and the verification results showed that the consistency index was 0.895(95%CI:0.858⁃0.932),and the slope of the calibration curve was close to 1,with a high net benefit rate.Conclusions The elevated value of preoperative SIINI indicates the risk of POD in elderly patients underwent LRP,and the nomogram model based on preoperative SIINI has high predictive value and clinical practicability.