The sensitivity and specificity of statistical rules for diagnosing delayed neurocognitive recovery with Montreal cognitive assessment in elderly surgical patients A cohort study
The sensitivity and specificity of statistical rules for diagnosing delayed neurocognitive recovery with Montreal cognitive assessment in elderly surgical patients A cohort study
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DOI：
10.1097/md.0000000000021193
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发表时间：
2020-07-17
期刊：
影响因子：
1.6
通讯作者：
Wang, Dong-Xin
中科院分区：
文献类型：
--
作者：
Hu, Jian;Li, Chun-Jing;Wang, Dong-Xin
延迟性神经认知恢复（DNR）在老年患者重大非心脏手术后较为常见。本研究旨在探讨在老年手术患者中使用蒙特利尔认知评估量表（MoCA）诊断DNR的最佳统计规则。这是一项队列研究。纳入了175名计划进行重大非心脏手术的老年（60岁及以上）患者。在手术前一天和手术后第五天使用一系列神经心理学测试和MoCA来测试认知功能。53名年龄和教育程度匹配的非手术对照受试者在相同时间间隔内使用相同工具完成认知评估。采用国际术后认知功能障碍研究（ISPOCD 1）的定义作为诊断DNR的标准参考。使用MoCA时，采用以下规则诊断DNR：截断点为 = 1.96。计算上述规则在诊断DNR时的敏感度、特异度以及受试者工作特征曲线下面积。根据ISPOCD1定义，DNR的发生率为13.1%（23/175）。与标准参考相比，2分规则在敏感度（82.6%，95%置信区间[CI] 67.1% - 98.1%）和特异度（82.2%，95% CI 76.2% - 88.3%）的组合上表现最佳；其受试者工作特征曲线下面积也最大（0.824，95% CI 0.728 - 0.921，P <.001）。截断点规则显示出高敏感度（95.7%）和低特异度（37.5%），而1个标准差和Z分数规则显示出低敏感度（分别为47.8%和21.7%）和高特异度（分别为93.4%和97.3%）。与ISPOCD1定义相比，使用MoCA的2分规则在诊断DNR时敏感度和特异度的组合最佳。
Delayed neurocognitive recovery (DNR) is common in elderly patients after major noncardiac surgery. This study was designed to investigate the best statistical rule in diagnosing DNR with the Montreal cognitive assessment (MoCA) in elderly surgical patients. This was a cohort study. One hundred seventy-five elderly (60 years or over) patients who were scheduled to undergo major noncardiac surgery were enrolled. A battery of neuropsychological tests and the MoCA were employed to test cognitive function at the day before and on fifth day after surgery. Fifty-three age- and education-matched nonsurgical control subjects completed cognitive assessment with the same instruments at the same time interval. The definition of the international study of postoperative cognitive dysfunction (ISPOCD 1) was adopted as the standard reference for diagnosing DNR. With the MoCA, the following rules were used to diagnose DNR: the cut-off point of = 1.96. The sensitivity and specificity as well as the area under receiver operating characteristic curve for the above rules in diagnosis of DNR were calculated. The incidence of DNR was 13.1% (23/175) according to the ISPOCD1 definition. When compared with the standard reference, the 2 scores rule showed the best combination of sensitivity (82.6%, 95% confidence interval [CI] 67.1%-98.1%) and specificity (82.2%, 95% CI 76.2%-88.3%); it also had the largest area under receiver operating characteristic curve (0.824, 95% CI 0.728-0.921,P < .001). The cut-off point rule showed high sensitivity (95.7%) and low specificity (37.5%), whereas the 1 standard deviation and theZscore rules showed low sensitivity (47.8% and 21.7%, respectively) and high specificity (93.4% and 97.3%, respectively). Compared with the ISPOCD1 definition, the 2 scores rule with MoCA had the best combination of sensitivity and specificity to diagnose DNR.