Preoperative Prognostic Nutritional Index Value is Related to Postoperative Delirium in Elderly Patients After Noncardiac Surgery: A Retrospective Cohort Study

He Liu; Mingsheng Dai; Huilian Guan; Xing Gao; Yang Zhou; Xun Sun; Jian Zhou; Xiaoyi Hu; Xiang Li; Yu Song; Yuan Han; Junli Cao

doi:10.2147/RMHP.S280567

Preoperative Prognostic Nutritional Index Value is Related to Postoperative Delirium in Elderly Patients After Noncardiac Surgery: A Retrospective Cohort Study

Risk Manag Healthc Policy. 2021 Jan 6:14:1-8. doi: 10.2147/RMHP.S280567. eCollection 2021.

Authors

He Liu^#^{1

2}, Mingsheng Dai^#^{1

3}, Huilian Guan¹, Xing Gao¹, Yang Zhou¹, Xun Sun¹, Jian Zhou¹, Xiaoyi Hu¹, Xiang Li¹, Yu Song¹, Yuan Han⁴, Junli Cao^{1

2}

Affiliations

¹ Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou City 221002, Jiangsu Province, People's Republic of China.
² Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou City 221004, Jiangsu Province, People's Republic of China.
³ Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China.
⁴ Department of Anesthesiology, Eye & ENT Hospital of Fudan University, Shanghai 20031, People's Republic of China.

^# Contributed equally.

Abstract

Purpose: Malnutrition has been considered as a risk factor for postoperative delirium (POD). The Prognostic Nutritional Index (PNI) is a validated tool for assessing nutritional status. This study aimed to investigate the association between preoperative PNI values and the occurrence of POD in elderly surgical patients.

Methods: The retrospective cohort study included 361 elderly individuals who underwent noncardiac surgery between 2018 and 2019. Perioperative data were collected from the patients' medical records. PNI was used to evaluate preoperative nutritional status. The primary outcome was the occurrence of POD. Univariate and multivariate logistic regression analyses were used to identify key factors associated with POD and assess the relationship between PNI values and the occurrence of POD. Receiver operating characteristic (ROC) curve analysis was used to assess the predictive value of PNI for POD.

Results: Seventy-two (19.9%) individuals developed postoperative delirium after surgery. Compared with patients of normal nutrition status (PNI ≥ 50), mild malnutrition (PNI 45-50) did not increase the risk of POD, while patients with moderate to severe malnutrition (PNI 40-45) (odds ratio [OR], 2.92; 95% confidence interval [CI], 1.31-6.50) and serious malnutrition (PNI < 40) (OR, 3.15; 95% CI, 1.12-8.83) were more likely to develop POD. The cut-off value of PNI was 46.05 by ROC curve analysis, the area under the curve (AUC) was 0.69 (95% CI 0.62-0.77).

Conclusion: Preoperative PNI value is related to postoperative delirium in elderly patients after noncardiac surgery.

Keywords: elderly patients; noncardiac surgery; nutritional status; postoperative delirium; prognostic nutritional index.

Grants and funding

This study was supported by the National Natural Science Foundation of China (81720108013, 31771161 to J.L. Cao; NSFC81300957 to H. Liu); Jiangsu Provincial Medical Youth Talent (QNRC2016795 to Y. Han), China Postdoctoral Science Foundation Funded Project (Project No. 2018T110556); the Natural Science Foundation of Jiangsu Province (BK20181145 to H. Liu), the Research Start-up Funding for Talent Introduction (2019203002 to H. Liu), and the Clinical Technical Research and Study Plan Project (2018211006 to H. Liu) .