Postoperative Delirium in Glioblastoma Patients: Risk Factors and Prognostic Implications
Postoperative Delirium in Glioblastoma Patients: Risk Factors and Prognostic Implications
复制标题
DOI：
10.1093/neuros/nyx606
复制
发表时间：
2018-12-01
期刊：
影响因子：
4.8
通讯作者：
Aghi, Manish K.
中科院分区：
文献类型：
--
作者：
Flanigan, Patrick M.;Jahangiri, Arman;Aghi, Manish K.
背景技术背景：谵妄是胶质母细胞瘤术后神经系统疾病，其危险因素、发病率和预后影响尚未明确。目的：开发一种使用术前因素预测术后谵妄的算法。方法：回顾性分析了2005年至2011年在我院接受首次胶质母细胞瘤手术的554例连续患者（平均年龄= 61.5岁; 42%为女性）。结果：7%的患者（n = 38）发生术后谵妄。接受活检的患者（10%; n = 54）未发生谵妄。在接受切除术的患者（n = 500）中，多变量logistic回归确定了5个独立预测术后谵妄的因素：年龄、慢性肺病、精神病史、双半球肿瘤和肿瘤大小。我们开发了一个名为“格拉德”（谵妄的胶质母细胞瘤风险评估）的评分函数，通过根据回归系数的相对大小为每个术前因素分配分数，将患者分为风险类别。对每位患者的总分进行求和：0 - 2分（n= 227）和3 - 7分（n= 221）的患者被指定为低风险和高风险，术后谵妄发生率分别为2%和15%（卡方; P
BACKGROUND: Delirium is a postoperative neurological morbidity in glioblastomawhose risk factors, incidence, and prognostic implications remain undefined.OBJECTIVE: To develop an algorithm using preoperative factors to predict postoperative delirium. METHODS: Retrospective analysis of 554 consecutive patients (mean age = 61.5 yr; 42% female) undergoing first glioblastoma procedure at our institution 2005 to 2011.RESULTS: Postoperative delirium occurred in 7% of patients (n = 38). Patients undergoing biopsy (10%; n = 54) did not experience delirium. In patients undergoing resection (n = 500), multivariate logistic regression identified 5 factors independently predicting postoperative delirium: age, chronic pulmonary disease, psychiatric history, bihemispheric tumors, and tumor size. We developed a score function entitled "GRAD" (Glioblastoma Risk Assessment for Delirium) to stratify patients into risk categories by assigning point(s) to each preoperative factor based on the relative magnitude of its regression coefficient. Point totalswere summed for each patient: patientswith 0 to 2 (n= 227) and 3 to 7 (n= 221) points were designated as low and high risk with postoperative delirium rates of 2% vs 15%, respectively (chi-square; P