Predictive value of combined detection of serum VCAM-1,PECAM-1 levels and MMSE score for postoperative delirium in elderly patients underwent total hip arthroplasty
- VernacularTitle:血清VCAM-1、PECAM-1水平与MMSE评分联合检测对老年全髋关节置换术患者术后谵妄的预测价值
- Author:
Fan LI
1
;
Shihuan LI
;
Shuang XIE
Author Information
- Keywords: arthroplasty,replacement,hip; delirious speech; postoperative cognitive complications; vascular cell adhesion molecule-1; platelet endothelial cell adhesion molecule-1; aged; mini mental state examination score
- From: Tianjin Medical Journal 2024;52(10):1046-1051
- CountryChina
- Language:Chinese
- Abstract: Objective To investigate the predictive value of combined detection of serum vascular cell adhesion molecule-1(VCAM-1),platelet endothelial cell adhesion molecule-1(PECAM-1)levels and mini mental state examination(MMSE)score for postoperative delirium(POD)in elderly patients underwent total hip arthroplasty(THA).Methods A total of 200 elderly patients with hip fracture underwent surgical treatment were selected as the research objects.Patients were divided into the POD group(n=44)and the non-POD group(n=156)according to whether POD occurred within 3 days after operation.The clinical data of patients in the two groups were collected.The preoperative cognitive status was evaluated by MMSE,and serum levels of VCAM-1 and PECAM-1 were detected before operation and 1st and 3rd day after operation.The differences of the above indexes between the two groups were compared,and the correlation between preoperative serum VCAM-1,PECAM-1 levels and MMSE score were analyzed.Multivariate Logistic regression analysis was utilized to investigate influencing factors of POD in elderly patients underwent THA.A receiver operating characteristic(ROC)curve was constructed to assess the predictive value of preoperative serum levels of VCAM-1 and PECAM-1,as well as MMSE score,both individually and in combination for POD in elderly patients undergoing THA.Results The age,hospital anxiety and depression scale score,incidence of intraoperative hypotension and postoperative hospital stay were significantly higher or longer in the POD group than those in the non-POD group,and the MMSE score was lower than that in the non-POD group(P＜0.05).The serum levels of VCAM-1 and PECAM-1 before operation,1st and 3rd day after operation were increased in the POD group,and which were significantly higher than those in the non-POD group(P＜0.05).The serum levels of VCAM-1 and PECAM-1 were significantly negatively correlated with MMSE score in elderly patients undergoing THA(r=-0.390,-0.501,P＜0.01).The elevated serum levels of VCAM-1 and PECAM-1 before operation and prolonged postoperative hospital stay were independent risk factors for POD in elderly patients underwent THA,and the elevated value of MMSE score was independent protective factor(P＜0.05).Preoperative serum VCAM-1(AUC=0.793,95%CI:0.730-0.847),PECAM-1(AUC=0.799,95%CI:0.736-0.852)and MMSE score(AUC=0.805,95%CI:0.744-0.858)showed high predictive value for POD in elderly patients underwent THA,and the combined detection of the three indicators had higher predictive efficiency.Conclusion The elevated serum levels of VCAM-1 and PECAM-1 are related to the impairment of cognitive function in elderly patients undergoing THA,and they are independent predictors for POD in elderly patients undergoing THA,thus may be helpful for early diagnosis and prevention of POD.
