Correlation between postoperative delirium and macrophage migration inhibitory factor in elderly patients after lower limb fracture surgery
Objective To explore the correlation of macrophage migration inhibitory factor(MIF)and postoperative delirium.Methods A total of 109 elderly patients(≥65 years)undergoing lower extremity fracture surgery under combined spinal-epidural block in our hospital from June 2022 to June 2023 were prospectively enrolled.Before operation,mini-mental state examination(MMSE)was used to evaluate the cognitive function of each participants,and their blood and cerebrospinal fluid(CSF)samples were harvested to detect MIF level by enzyme linked immunosorbent assay(ELISA).After operation,confusion assessment method Chinese reversion(CAM-CR)was used to assess delirium,and according to the results,they were divided into delirium group(POD group,n=13)and non-delirium group(NPOD group,n=96).SPSS statistics 26.0 was used for data analysis.Depending on data type,student's t test or Mann-Whitney U test was used for comparison between groups.Multivariate logistic regression model was used to analyze the risk factors of lower limb surgery in elderly patients.Receiver operating characteristic(ROC)curve was plotted to calculate the area under the ROC curve(AUC)to evaluate the diagnostic value of MIF.Spearman correlation analysis was employed to analyze the correlation between MIF and MMSE score.Results Among the 109 elderly patients,the incidence of delirium was 11.93％(13/109).Before operation,the MIF levels in the CSF and blood were significantly higher in the POD group than the NPOD group(P<0.05).Multivariate logistic regression analysis showed that preoperative MIF levels in CSF(OR=1.273,95％CI 1.120-1.446;P<0.001)and blood(OR=1.016,95％CI 1.001-1.031;P=0.032)were independent risk factors for postoperative delirium in elderly patients after lower limb fracture surgery.The AUC value of CSF and blood MIF levels in predicting POD was 0.877(95％CI 0.799-0.956)and 0.884(95％CI 0.819-0.949),the sensitivity was 81.50％and 76.84％,and the specificity was 84.62％and 100.00％,respec-tively.The Youden index was 0.66 and 0.77,which were statistically significant(P<0.0001).Spearman correlation analysis showed that CSF and blood MIF levels were negatively correlated with MMSE score(r=-0.335,-0.286;P<0.05).Conclusion Preoperative MIF level is closely associated with the occurrence of POD in elderly patients after surgery,and has the potential to be used as a biomarker to predict POD.MIF can reflect cognitive level,and is negatively correlated with MMSE score.The higher the CSF and blood MIF levels,the lower the MMSE score.
NETL
NSTL
万方数据
