Influencing factors of neurocognitive dysfunction after total knee arthroplasty and the construction of a nomogram model

doi:10.11958/20241375

Abstract

Abstract:

Objective To explore the influencing factors of neurocognitive dysfunction (PND) in patients with total knee arthroplasty (TKA) and construct a nomogram prediction model. Methods The clinical data of 249 patients with TKA admitted to our hospital from December 2022 to July 2024 were selected. Patients were divided into the modeling queue (n=174) and the verification queue (n=75) according to the ratio of 7∶3. At the same time, according to whether patients developed PND or not, the modeling queue was divided into the PND group (n=62) and the non-PND group (n=112), and the verification queue was divided into the PND group (n=27) and the non-PND group (n=48). The influencing factors of PND in TKA patients were analyzed, and a nomogram prediction model was established to verify. Results High debilitation score, general anesthesia, single analgesic regimen and high VAS score were risk factors of PND, while high albumin and hemoglobin levels were protective factors of PND (P<0.05). The nomogram model was constructed, and the AUC of PND in the modeling queue and the verification queue was 0.875 (95%CI: 0.824-0.925) and 0.905 (95%CI:0.835-0.975) respectively. The results of calibration curve analysis showed that the predicted risk of PND was basically consistent with the actual situation, and the results of Hosmer-Lemeshow showed that the model fit well. The results of clinical decision curve showed that the model had high clinical application value. Conclusion High debilitating score, general anesthesia, single analgesic regimen, high VAS score and low albumin and hemoglobin levels can increase the risk of PND in TKA patients. The nomogram prediction model constructed in this study is helpful for clinical identification of high-risk groups of PND.

Key words: arthroplasty, replacement, knee, cognitive dysfunction, Logistic models, nomograms

CLC Number:

R684

Figures/Tables 10

References 23

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组别	n	性别（男/女）	年龄/岁	BMI/ （kg/m²）	呼吸系统疾病（有/无）	基础疾病（有/无）	衰弱评分/分	术侧^a	手术时间/min	麻醉时间/min	术中出血量/mL
建模队列	174	64/110	62.70±5.90	24.11±2.54	43/131	57/117	2.41±0.76	85/89	112.27±26.90	129.58±26.81	206.71±25.19
验证队列	75	23/52	62.78±5.68	24.12±2.57	18/57	29/46	2.42±0.84	31/44	108.27±24.35	128.76±25.32	203.87±25.33
χ²或t		0.862	0.090	0.016	0.014	0.809	0.103	1.190	1.108	0.225	0.888
组别		麻醉方式^b	镇痛方案^c	VAS评分/分	ALB/（g/L）	RBC/（×10¹²/L）	HB/（g/L）		WBC/（×10⁹/L）	NEU/（×10⁹/L）	LYM/（×10⁹/L）
建模队列		83/91	82/92	5.51±2.09	39.40±4.16	4.32±0.51	115.51±18.54		6.75±1.60	4.19±1.23	2.05±0.98
验证队列		34/41	38/37	5.55±1.86	39.17±4.49	4.38±0.46	114.22±16.93		6.74±1.63	4.27±1.16	2.07±0.94
t		0.118	0.263	0.126	0.393	0.886	0.515		0.053	0.445	0.219

组别	n	性别（男/女）	年龄/岁	BMI/ （kg/m²）	呼吸系统疾病（有/无）	基础疾病（有/无）	衰弱评分/分	术侧^a	手术时间/min	麻醉时间/min	术中出血量/mL
建模队列	174	64/110	62.70±5.90	24.11±2.54	43/131	57/117	2.41±0.76	85/89	112.27±26.90	129.58±26.81	206.71±25.19
验证队列	75	23/52	62.78±5.68	24.12±2.57	18/57	29/46	2.42±0.84	31/44	108.27±24.35	128.76±25.32	203.87±25.33
χ²或t		0.862	0.090	0.016	0.014	0.809	0.103	1.190	1.108	0.225	0.888
组别		麻醉方式^b	镇痛方案^c	VAS评分/分	ALB/（g/L）	RBC/（×10¹²/L）	HB/（g/L）		WBC/（×10⁹/L）	NEU/（×10⁹/L）	LYM/（×10⁹/L）
建模队列		83/91	82/92	5.51±2.09	39.40±4.16	4.32±0.51	115.51±18.54		6.75±1.60	4.19±1.23	2.05±0.98
验证队列		34/41	38/37	5.55±1.86	39.17±4.49	4.38±0.46	114.22±16.93		6.74±1.63	4.27±1.16	2.07±0.94
t		0.118	0.263	0.126	0.393	0.886	0.515		0.053	0.445	0.219

组别	n	性别（男/女）		年龄/ 岁		BMI/（kg/m²）		呼吸系统疾病（有/无）		基础疾病（有/无）	衰弱评分/分		术侧^a		手术时间/min		麻醉时间/min		术中出血量/mL
非PND组	112	43/69		62.38±5.33		23.89±2.39		32/80		33/79	2.18±0.63		58/54		110.84±26.57		127.55±25.76		208.33±26.45
PND组	62	21/41		63.27±6.82		24.52±2.76		11/51		24/38	2.85±0.81		27/35		114.86±27.50		133.24±28.45		204.52±22.74
χ²或t		0.351		0.953		1.571		2.516		1.549	6.087^＊＊		1.084		0.944		1.346		0.953
组别	麻醉方式^b		镇痛方案^c		VAS评分/分		ALB/（g/L）		RBC/（×10¹²/L）			HB/（g/L）		WBC/（×10⁹/L）		NEU/（×10⁹/L）		LYM/（×10⁹/L）
非PND组	44/68		45/67		5.16±1.84		40.65±3.84		4.27±0.49			118.09±17.99		6.71±1.54		4.20±1.23		1.99±0.89
PND组	39/23		37/25		6.15±2.38		37.15±3.77		4.41±0.54			110.84±18.76		6.82±1.70		4.18±1.25		2.16±1.13
χ²或t	8.923^＊＊		6.089^＊		3.080^＊		5.798^＊＊		1.761			2.505^＊		0.469		0.055		1.092

组别	n	性别（男/女）		年龄/ 岁		BMI/（kg/m²）		呼吸系统疾病（有/无）		基础疾病（有/无）	衰弱评分/分		术侧^a		手术时间/min		麻醉时间/min		术中出血量/mL
非PND组	112	43/69		62.38±5.33		23.89±2.39		32/80		33/79	2.18±0.63		58/54		110.84±26.57		127.55±25.76		208.33±26.45
PND组	62	21/41		63.27±6.82		24.52±2.76		11/51		24/38	2.85±0.81		27/35		114.86±27.50		133.24±28.45		204.52±22.74
χ²或t		0.351		0.953		1.571		2.516		1.549	6.087^＊＊		1.084		0.944		1.346		0.953
组别	麻醉方式^b		镇痛方案^c		VAS评分/分		ALB/（g/L）		RBC/（×10¹²/L）			HB/（g/L）		WBC/（×10⁹/L）		NEU/（×10⁹/L）		LYM/（×10⁹/L）
非PND组	44/68		45/67		5.16±1.84		40.65±3.84		4.27±0.49			118.09±17.99		6.71±1.54		4.20±1.23		1.99±0.89
PND组	39/23		37/25		6.15±2.38		37.15±3.77		4.41±0.54			110.84±18.76		6.82±1.70		4.18±1.25		2.16±1.13
χ²或t	8.923^＊＊		6.089^＊		3.080^＊		5.798^＊＊		1.761			2.505^＊		0.469		0.055		1.092

变量	β	SE	Wald χ²	P	OR（95%CI）
衰弱评分	1.322	0.314	17.743	<0.001	3.752 (2.028~6.943)
麻醉方式	1.082	0.425	6.474	0.011	2.949 (1.282~6.785)
镇痛方案	1.092	0.442	6.109	0.013	2.980 (1.254~7.083)
VAS评分	0.262	0.101	6.723	0.010	1.300 (1.066~1.584)
ALB	-0.214	0.057	13.941	<0.001	0.807 (0.721~0.903)
HB	-0.036	0.012	8.491	0.004	0.964 (0.941~0.988)
常数项	5.961	2.694	4.897	0.027	388.178