Establish a Nomogram of Cardiac Postoperative Cognitive Dysfunction
Keywords:cardiac postoperative cognitive dysfunction (c-POCD), nomogram;, risk factors
Objectives: Cardiac postoperative cognitive dysfunction (c-POCD) is a common complication. This article established a nomogram by analyzing preoperative and intraoperative data to help identify high-risk patients and take effective management for prevention of c-POCD in early stage.
Measurements and main results: A total of 265 patients were enrolled in this study, 27 of whom were diagnosed as cardiac postoperative cognitive dysfunction (c-POCD). Patients were divided into a control group and c-POCD group. Univariate analysis suggested that gender, smoking, drinking history, hypertension, white blood cell (WBC) count, aspartate aminotransferase (AST), high-sensitivity troponin (hs-CRP), arrhythmia, left atrial diameter (LAD), cardiopulmonary bypass (CPB) time, and the ascending aortic block (AAB) time were correlated with postoperative cognitive dysfunction after cardiac surgery. Multivariate regression analysis indicated that CPB time (P = 0.0015, OR (95% CI) = 6.696 (2.068-21.675), hypertension (P = 0.0098, OR (95%CI) = 3.776 (1.377-10.356), WBC count (P = 0.0227, OR (95%CI ) = 3.358 (1.184-9.522), AST (P = 0.0128, OR (95%CI) = 3.966 (1.340-11.735), and arrhythmia (P = 0.0017, OR (95%CI) = 5.164 (1.855-14.371) were the independent risk factors of cognitive dysfunction after cardiac surgery and used to establish a nomogram for clinical use. The initial C-index of the nomogram was 0.8182 and good calibration. Corrected C-index value of 0.793 was reached after internal validation. The area under ROC curve of this model was 0.8188 (95%CI: 0.7185-0.9190). The positive odds ratio (PLR) was 1.21 (95%CI: 1.1-1.3), and the negative odds ratio (NLR) was 0.18 (95%CI: 0.03-1.3).
Conclusion: This nomogram incorporating the CPB time, hypertension, WBC count, AST, and arrhythmia to predict the risk of c-POCD. The internal validation shows a good forecasting effect.
Akoudad S, Darweesh SK, Leening MJ, et al. 2014. Use of coumarin anticoagulants and cerebral microbleeds in the general population. Stroke; a journal of cerebral circulation. 45(11):3436-3439.
Bi Y, Liu S, Yu X, Wu M, Wang Y. 2014. Adaptive and regulatory mechanisms in aged rats with postoperative cognitive dysfunction. Neural regeneration research. 9(5):534-539.
Brady K, Joshi B, Zweifel C, et al. 2010. Real-time continuous monitoring of cerebral blood flow autoregulation using near-infrared spectroscopy in patients undergoing cardiopulmonary bypass. Stroke. 41(9):1951-1956.
Bucak N, Begec Z, Erdil F, et al. 2014. Postoperative cognitive dysfunction in living liver transplant donors. Experimental and clinical transplantation: official journal of the Middle East Society for Organ Transplantation. 12 Suppl 1:81-85.
Cacciatore F, Testa G, Langellotto A, et al. 2012. Role of ventricular rate response on dementia in cognitively impaired elderly subjects with atrial fibrillation: a 10-year study. Dementia and geriatric cognitive disorders. 34(3-4):143-148.
Canet J, Raeder J, Rasmussen LS, et al. 2003. Cognitive dysfunction after minor surgery in the elderly. Acta anaesthesiologica Scandinavica. 47(10):1204-1210.
Di Tomasso N, Monaco F, Landoni G. 2015. Hepatic and renal effects of cardiopulmonary bypass. Best practice & research Clinical anaesthesiology. 29(2):151-161.
Evered L, Scott DA, Silbert B, Maruff P. 2011. Postoperative cognitive dysfunction is independent of type of surgery and anesthetic. Anesth Analg. 112(5):1179-1185.
Folstein MF, Folstein SE, McHugh PR. 1975. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 12(3):189-198.
Gao L, Taha R, Gauvin D, Othmen LB, Wang Y, Blaise G. 2005. Postoperative cognitive dysfunction after cardiac surgery. Chest. 128(5):3664-3670.
Gottesman RF, Grega MA, Bailey MM, et al. 2010. Delirium after coronary artery bypass graft surgery and late mortality. Annals of neurology. 67(3):338-344.
Hessel EA, 2nd. 2015. History of cardiopulmonary bypass (CPB). Best practice & research Clinical anaesthesiology. 29(2):99-111.
Heyer EJ, Sharma R, Rampersad A, et al. 2002. A controlled prospective study of neuropsychological dysfunction following carotid endarterectomy. Archives of neurology. 59(2):217-222.
Hudetz JA, Gandhi SD, Iqbal Z, Patterson KM, Pagel PS. 2011. Elevated postoperative inflammatory biomarkers are associated with short- and medium-term cognitive dysfunction after coronary artery surgery. J Anesth. 25(1):1-9.
Iasonos A, Schrag D, Raj GV, Panageas KS. 2008. How to build and interpret a nomogram for cancer prognosis. Journal of clinical oncology: official journal of the American Society of Clinical Oncology. 26(8):1364-1370.
Kalman J, Juhasz A, Bogats G, et al. 2006. Elevated levels of inflammatory biomarkers in the cerebrospinal fluid after coronary artery bypass surgery are predictors of cognitive decline. Neurochemistry international. 48(3):177-180.
Kawai K, Ishihara S, Yamaguchi H, et al. 2015. Nomogram prediction of metachronous colorectal neoplasms in patients with colorectal cancer. Annals of surgery. 261(5):926-932.
Koster S, Hensens AG, Schuurmans MJ, van der Palen J. 2012. Consequences of delirium after cardiac operations. The Annals of thoracic surgery. 93(3):705-711.
Koster S, Oosterveld FG, Hensens AG, Wijma A, van der Palen J. 2008. Delirium after cardiac surgery and predictive validity of a risk checklist. The Annals of thoracic surgery. 86(6):1883-1887.
Launer LJ, Dinkgreve MA, Jonker C, Hooijer C, Lindeboom J. 1993. Are age and education independent correlates of the Mini-Mental State Exam performance of community-dwelling elderly? Journal of gerontology. 48(6):P271-277.
Mangusan RF, Hooper V, Denslow SA, Travis L. 2015. Outcomes associated with postoperative delirium after cardiac surgery. American journal of critical care: an official publication, American Association of Critical-Care Nurses. 24(2):156-163.
Monk TG, Weldon BC, Garvan CW, et al. 2008. Predictors of cognitive dysfunction after major noncardiac surgery. Anesthesiology. 108(1):18-30.
Nasreddine ZS, Phillips NA, Bedirian V, et al. 2005. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 53(4):695-699.
Rasmussen LS. 2006. Postoperative cognitive dysfunction: incidence and prevention. Best practice & research Clinical anaesthesiology. 20(2):315-330.
Richards M, Meade TW, Peart S, Brennan PJ, Mann AH. 1997. Is there any evidence for a protective effect of antithrombotic medication on cognitive function in men at risk of cardiovascular disease? Some preliminary findings. Journal of neurology, neurosurgery, and psychiatry. 62(3):269-272.
Shaw S, Wang X, Redd H, Alexander GD, Isales CM, Marrero MB. 2003. High glucose augments the angiotensin II-induced activation of JAK2 in vascular smooth muscle cells via the polyol pathway. The Journal of biological chemistry. 278(33):30634-30641.
Silverstein JH, Timberger M, Reich DL, Uysal S. 2007. Central nervous system dysfunction after noncardiac surgery and anesthesia in the elderly. Anesthesiology. 106(3):622-628.
van Harten AE, Scheeren TW, Absalom AR. 2012. A review of postoperative cognitive dysfunction and neuroinflammation associated with cardiac surgery and anaesthesia. Anaesthesia. 67(3):280-293.
Wan Y, Xu J, Ma D, Zeng Y, Cibelli M, Maze M. 2007. Postoperative impairment of cognitive function in rats: a possible role for cytokine-mediated inflammation in the hippocampus. Anesthesiology. 106(3):436-443.
Wan Y, Xu J, Meng F, et al. 2010. Cognitive decline following major surgery is associated with gliosis, beta-amyloid accumulation, and tau phosphorylation in old mice. Critical care medicine. 38(11):2190-2198.
Wu Y, Chen T. 2016. An Up-to-Date Review on Cerebral Microbleeds. Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association. 25(6):1301-1306.
Yuan SM. 2012. Cardiac surgical procedures for the coronary sequelae of Kawasaki disease. The Libyan journal of medicine. 7:19796.
Zhang WY, Wu WL, Gu JJ, et al. 2015. Risk factors for postoperative delirium in patients after coronary artery bypass grafting: A prospective cohort study. Journal of critical care. 30(3):606-612.
How to Cite
Author Disclosure & Copyright Transfer Agreement
In order to publish the original work of another person(s), The Heart Surgery Forum® must receive an acknowledgment of the Author Agreement and Copyright Transfer Statement transferring to Forum Multimedia Publishing, L.L.C., a subsidiary of Carden Jennings Publishing Co., Ltd. the exclusive rights to print and distribute the author(s) work in all media forms. Failure to check Copyright Transfer agreement box below will delay publication of the manuscript.
A current form follows:
The author(s) hereby transfer(s), assign(s), or otherwise convey(s) all copyright ownership of the manuscript submitted to Forum Multimedia Publishing, LLC (Publisher). The copyright transfer covers the exclusive rights to reproduce and distribute the article and the material contained therein throughout the world in all languages and in all media of expression now known or later developed, including but not limited to reprints, photographic reproduction, microfilm, electronic data processing (including programming, storage, and transmission to other electronic data record(s), or any other reproductions of similar nature), and translations.
However, Publisher grants back to the author(s) the following:
- The right to make and distribute copies of all or part of this work for use of the author(s) in teaching;
- The right to use, after publication in The Heart Surgery Forum, all or part of the material from this work in a book by the author(s), or in a collection of work by the author(s);
- The royalty-free right to make copies of this work for internal distribution within the institution/company that employs the author(s) subject to the provisions below for a work-made-for-hire;
- The right to use figures and tables from this work, and up to 250 words of text, for any purpose;
- The right to make oral presentations of material from this work.
Publisher reserves the right to grant or refuse permission to third parties to republish all or part of the article or translations thereof. To republish, such third parties must obtain written permission from the Publisher. (This is in accordance with the Copyright Statute, United States Code, Title 17. Exception: If all authors were bona fide officers or employees of the U.S. Government at the time the paper was prepared, the work is a “work of the US Government” (prepared by an officer or employee of the US Government as part of official duties), and therefore is not subject to US copyright; such exception should be indicated on signature lines. If this work was prepared under US Government contract or grant, the US Government may reproduce, royalty-free, all or portions of this work and may authorize others to do so, for official US Government purposes only, if the US Government contract or grant so requires.
I have participated in the conception and design of this work and in the writing of the manuscript and take public responsibility for it. Neither this manuscript nor one with substantially similar content under my authorship has been published, has been submitted for publication elsewhere, or will be submitted for publication elsewhere while under consideration by The Heart Surgery Forum, except as described in an attachment. I have reviewed this manuscript (original version) and approve its submission. If I am listed above as corresponding author, I will provide all authors with information regarding this manuscript and will obtain their approval before submitting any revision. I attest to the validity, accuracy, and legitimacy of the content of the manuscript and understand that Publisher assumes no responsibility for the validity, accuracy, and legitimacy of its content. I warrant that this manuscript is original with me and that I have full power to make this Agreement. I warrant that it contains no matter that is libelous or otherwise unlawful or that invades individual privacy or infringes any copyright or other proprietary right. I agree to indemnify and hold Publisher harmless of and from any claim made against Publisher that relates to or arises out of the publication of the manuscript and agree that this indemnification shall include payment of all costs and expenses relating to the defense of any such claim, including all reasonable attorney’s fees.
I warrant that I have no financial interest in the drugs, devices, or procedures described in the manuscript (except as disclosed in the attached statement).
I state that the institutional Human Subjects Committee and/or the Ethics Committee approved the clinical protocol reported in this manuscript for the use of experimental techniques, drugs, or devices in human subjects and appropriate informed consent documents were utilized.
Furthermore, I state that any and all animals used for experimental purposes received humane care in USDA registered facilities in compliance with the “Principles of Laboratory Animal Care” formulated by the National Society for Medical Research and the “Guide for the Care and Use of Laboratory Animals” prepared by the Institute of Laboratory Animal Resources and published by the National Institutes of Health (NIH Publication No. 85-23, revised 1985).