Development of a Disease Model for Predicting Postoperative Delirium Using Combined Blood Biomarkers.

OBJECTIVE

Postoperative delirium, a common neurocognitive complication after surgery and anesthesia, requires early detection for potential intervention. Herein, we constructed a multidimensional postoperative delirium risk-prediction model incorporating multiple demographic parameters and blood biomarkers to enhance prediction accuracy.

METHODS

We included 555 patients undergoing radical surgery for colorectal cancer. Demographic characteristics and lipid profiles were collected preoperatively, and perioperative anesthesia and surgical conditions were recorded; blood biomarkers were measured before and after surgery. The 3D-CAM scale was used to assess postoperative delirium occurrence within 3 days after surgery. Patients were divided into the postoperative delirium (N = 100) and non-postoperative delirium (N = 455) groups. Based on machine learning, linear and nine non-linear models were developed and compared to select the optimal model. Shapley value-interpretation methods and mediation analysis were used to assess feature importance and interaction.

RESULTS

The median age of the participants was 65 years (interquartile range: 56-71 years; 57.8% male). Among the 10 machine-learning models, the random forest model performed the best (validation cohort, area under the receiver operating characteristic curve of 0.795 [0.704-0.885]). Lipid profile (total cholesterol, triglycerides, and trimethylamine-N-oxide) levels were identified as key postoperative delirium predictors. Mediation analysis further confirmed mediating effects among total cholesterol, trimethylamine-N-oxide, and postoperative delirium; a nomogram model was developed as a web-based tool for external validation and use by other clinicians.

INTERPRETATION: Blood biomarkers are crucial in predicting postoperative delirium and aid anesthesiologists in identifying its risks in a timely manner. This model facilitates personalized perioperative management and reduces the occurrence of postoperative delirium.

TRIAL REGISTRATION: ChiCTR2300075723.