{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T01:49:40Z","timestamp":1792460980368,"version":"4.5.0"},"reference-count":39,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,9,8]],"date-time":"2022-09-08T00:00:00Z","timestamp":1662595200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003397","name":"2021 Independent Innovation Fund of School of Nursing, Tongji Medical College, Huazhong University of Science and Technology","doi-asserted-by":"publisher","award":["2021-3-1"],"award-info":[{"award-number":["2021-3-1"]}],"id":[{"id":"10.13039\/501100003397","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Postoperative delirium (POD) is a common postoperative complication after cardiovascular surgery with adverse outcomes. No prediction tools are currently available for assessing POD in the type B aortic dissection (TBAD) population. The purposes of this study were to develop and validate a nomogram for predicting POD among TBAD patients who underwent thoracic endovascular aortic repair (TEVAR).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The retrospective cohort included 631 eligible TBAD patients who underwent TEVAR from January 2019 to July 2021. 434 patients included before 2021 were in the develop set; 197 others were in the independent validation set. Least absolute shrinkage and selection operator (LASSO) and logistic regression were applied to identify the most useful predictive variables for constructing the nomogram. Discrimination and the agreement of the model was assessed with the area under the receiver operating characteristic curve (AUC), Brier score and the Hosmer-Lemeshow goodness-of-fit test. The results were validated using a bootstrap resampling and the validation set.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The incidence rate of POD observed in the development and validation cohort were 15.0% and 14.2%, respectively. Seven independent risk factors, including age \u226560 years, syncope or coma, postoperative blood transfusion, atelectasis, estimated glomerular filtration rate (eGFR) &amp;lt;80\u2005ml\/min\/1.73\u2005m<jats:sup>2<\/jats:sup>, albumin &amp;lt;30\u2005g\/L, and neutrophil to lymphocyte ratio, were included in the nomogram. The model showed a good discrimination with an AUC of 0.819 (95% CI, 0.762\u20130.876) in the developed set, and adjusted to 0.797 (95% CI, 0.735\u20130.849) and 0.791 (95% CI, 0.700\u20130.881) in the internal validation set and the external validation, respectively. Favorable calibration of the nomogram was confirmed in both the development and validation cohorts.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The nomogram based on seven readily available predictors has sufficient validity to identify POD risk in this population. This tool may facilitate targeted initiation of POD preventive intervention for healthcare providers.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fsurg.2022.986185","type":"journal-article","created":{"date-parts":[[2022,11,16]],"date-time":"2022-11-16T11:25:43Z","timestamp":1668597943000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":10,"title":["Development and validation of a nomogram to predict postoperative delirium in type B aortic dissection patients underwent thoracic endovascular aortic repair"],"prefix":"10.3389","volume":"9","author":[{"given":"Wanbing","family":"Huang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiansheng","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yufen","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chong","family":"Tian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haishan","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Mao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,9,8]]},"reference":[{"key":"B1","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1161\/CIRCULATIONAHA.110.958975","article-title":"Acute aortic dissection: clinician update","volume":"122","author":"Braverman","year":"2010","journal-title":"Circulation"},{"key":"B2","doi-asserted-by":"crossref","first-page":"1846","DOI":"10.1161\/CIRCULATIONAHA.117.031264","article-title":"Insights from the international registry of acute aortic dissection: a 20-year experience of collaborative clinical research","volume":"137","author":"Evangelista","year":"2018","journal-title":"Circulation"},{"key":"B3","doi-asserted-by":"crossref","first-page":"848","DOI":"10.1148\/radiol.14131457","article-title":"Aortic arch dissection: a controversy of classification","volume":"271","author":"Lempel","year":"2014","journal-title":"Radiology"},{"key":"B4","doi-asserted-by":"publisher","first-page":"556","DOI":"10.1177\/0003319720987956","article-title":"Influence of sex on outcomes after thoracic endovascular repair for type B aortic dissection","volume":"72","author":"Luo","year":"2021","journal-title":"Angiology"},{"key":"B5","doi-asserted-by":"crossref","first-page":"2873","DOI":"10.1093\/eurheartj\/ehu281","article-title":"2014 ESC guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The task force for the diagnosis and treatment of aortic diseases of the European society of cardiology (ESC)","volume":"35","author":"Erbel","year":"2014","journal-title":"Eur Heart J"},{"key":"B6","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1093\/ejcts\/ezy313","article-title":"Current options and recommendations for the treatment of thoracic aortic pathologies involving the aortic arch: an expert consensus document of the European Association for Cardio-Thoracic surgery (EACTS) and the European Society for Vascular Surgery (ESVS)","volume":"55","author":"Czerny","year":"2019","journal-title":"Eur J Cardiothorac Su"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1574","DOI":"10.1177\/0300060517708893","article-title":"Treatment of serious complications following endovascular aortic repair for type B thoracic aortic dissection","volume":"45","author":"Liu","year":"2017","journal-title":"J Int Med Res"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1202","DOI":"10.1213\/ANE.0b013e3182147f6d","article-title":"Review articles: postoperative delirium: acute change with long-term implications","volume":"112","author":"Rudolph","year":"2011","journal-title":"Anesth Analg"},{"key":"B9","doi-asserted-by":"publisher","first-page":"e420","DOI":"10.1136\/bmj.e420","article-title":"Development and validation of PRE-DELIRIC (PREdiction of DELIRium in ICu patients) delirium prediction model for intensive care patients: observational multicentre study","volume":"344","author":"van den Boogaard","year":"2012","journal-title":"BMJ (Clin Res Ed)"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1269","DOI":"10.1016\/j.jvs.2017.04.077","article-title":"A systematic review and meta-analysis of factors for delirium in vascular surgical patients","volume":"66","author":"Oldroyd","year":"2017","journal-title":"J Vasc Surg"},{"key":"B11","doi-asserted-by":"publisher","first-page":"1581","DOI":"10.2147\/CIA.S328657","article-title":"Incidence, predictors and outcomes of delirium in complicated type B aortic dissection patients after thoracic endovascular aortic repair","volume":"16","author":"Liu","year":"2021","journal-title":"Clin Interv Aging"},{"key":"B12","doi-asserted-by":"publisher","first-page":"572581","DOI":"10.3389\/fmed.2020.572581","article-title":"Prevalence, predictors, and early outcomes of post-operative delirium in patients with type A aortic dissection during intensive care unit stay","volume":"7","author":"Cai","year":"2020","journal-title":"Front Med (Lausanne)"},{"key":"B13","doi-asserted-by":"publisher","first-page":"2109","DOI":"10.1111\/jocn.14365","article-title":"The relationship of delirium and risk factors for cardiology intensive care unit patients with the nursing workload","volume":"27","author":"\u00d6zt\u00fcrk Birge","year":"2018","journal-title":"J Clin Nurs"},{"key":"B14","doi-asserted-by":"publisher","first-page":"512","DOI":"10.1001\/jamainternmed.2014.7779","article-title":"Effectiveness of multicomponent nonpharmacological delirium interventions: a meta-analysis","volume":"175","author":"Hshieh","year":"2015","journal-title":"JAMA Intern Med"},{"key":"B15","doi-asserted-by":"publisher","first-page":"146","DOI":"10.1186\/s13019-021-01529-4","article-title":"Plasma interleukin-6 is a potential predictive biomarker for postoperative delirium among acute type a aortic dissection patients treated with open surgical repair","volume":"16","author":"Lv","year":"2021","journal-title":"J Cardiothorac Surg"},{"key":"B16","doi-asserted-by":"publisher","first-page":"334","DOI":"10.1186\/s12877-021-02284-w","article-title":"Neutrophil-lymphocyte ratio as a predictor of delirium in older internal medicine patients: a prospective cohort study","volume":"21","author":"Zhao","year":"2021","journal-title":"BMC Geriatr"},{"key":"B17","doi-asserted-by":"publisher","first-page":"W1","DOI":"10.7326\/M14-0698","article-title":"Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD): explanation and elaboration","volume":"162","author":"Moons","year":"2015","journal-title":"Ann Intern Med"},{"key":"B18","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1213\/ANE.0000000000004386","article-title":"Development of a risk score to predict postoperative delirium in patients with hip fracture","volume":"130","author":"Kim","year":"2020","journal-title":"Anesth Analg"},{"key":"B19","doi-asserted-by":"publisher","first-page":"312","DOI":"10.1111\/j.1532-5415.2005.53120.x","article-title":"A chart-based method for identification of delirium: validation compared with interviewer ratings using the confusion assessment method","volume":"53","author":"Inouye","year":"2005","journal-title":"J Am Geriatr Soc"},{"key":"B20","doi-asserted-by":"publisher","first-page":"R121","DOI":"10.1186\/cc5027","article-title":"A research algorithm to improve detection of delirium in the intensive care unit","volume":"10","author":"Pisani","year":"2006","journal-title":"Crit Care"},{"key":"B21","doi-asserted-by":"publisher","first-page":"m441","DOI":"10.1136\/bmj.m441","article-title":"Calculating the sample size required for developing a clinical prediction model","volume":"368","author":"Riley","year":"2020","journal-title":"BMJ (Clin Res Ed)"},{"key":"B22","doi-asserted-by":"publisher","first-page":"2881","DOI":"10.2337\/dc13-0428","article-title":"Validation of a pretransplant risk score for new-onset diabetes after kidney transplantation","volume":"36","author":"Chakkera","year":"2013","journal-title":"Diabetes Care"},{"key":"B23","doi-asserted-by":"publisher","first-page":"772675","DOI":"10.3389\/fsurg.2021.772675","article-title":"Construction and application of a model for predicting the risk of delirium in postoperative patients with type a aortic dissection","volume":"8","author":"He","year":"2021","journal-title":"Front Surg"},{"key":"B24","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1186\/s13019-020-01217-9","article-title":"Risk factors for postoperative delirium in patients with triple-branched stent graft implantation","volume":"15","author":"Lin","year":"2020","journal-title":"J Cardiothorac Surg"},{"key":"B25","doi-asserted-by":"publisher","first-page":"1048","DOI":"10.1007\/s00134-015-3777-2","article-title":"Multinational development and validation of an early prediction model for delirium in ICU patients","volume":"41","author":"Wassenaar","year":"2015","journal-title":"Intensive Care Med"},{"key":"B26","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1097\/ALN.0b013e318190b4d9","article-title":"Preoperative use of statins is associated with reduced early delirium rates after cardiac surgery","volume":"110","author":"Katznelson","year":"2009","journal-title":"Anesthesiology"},{"key":"B27","doi-asserted-by":"publisher","first-page":"361","DOI":"10.1007\/s00134-013-3202-7","article-title":"Recalibration of the delirium prediction model for ICU patients (PRE-DELIRIC): a multinational observational study","volume":"40","author":"van den Boogaard","year":"2014","journal-title":"Intensive Care Med"},{"key":"B28","doi-asserted-by":"publisher","first-page":"192","DOI":"10.1097\/EJA.0000000000000594","article-title":"European Society of anaesthesiology evidence-based and consensus-based guideline on postoperative delirium","volume":"34","author":"Aldecoa","year":"2017","journal-title":"Eur J Anaesthesiol"},{"key":"B29","year":"2010"},{"key":"B30","doi-asserted-by":"publisher","first-page":"1572","DOI":"10.1213\/ANE.0000000000004641","article-title":"American society for enhanced recovery and perioperative quality initiative joint consensus statement on postoperative delirium prevention","volume":"130","author":"Hughes","year":"2020","journal-title":"Anesth Analg"},{"key":"B31","doi-asserted-by":"publisher","first-page":"506","DOI":"10.1111\/j.1755-5949.2010.00173.x","article-title":"The role of inflammation in the pathogenesis of delirium and dementia in older adults: a review","volume":"17","author":"Simone","year":"2011","journal-title":"CNS Neurosci Ther"},{"key":"B32","doi-asserted-by":"publisher","first-page":"e9731854","DOI":"10.1155\/2020\/9731854","article-title":"Diagnostic value of neutrophil-lymphocyte ratio for predicting the severity of acute pancreatitis: a meta-analysis","volume":"2020","author":"Kong","year":"2020","journal-title":"Dis Markers"},{"key":"B33","doi-asserted-by":"publisher","first-page":"e825","DOI":"10.1097\/CCM.0000000000003299","article-title":"Clinical practice guidelines for the prevention and management of pain, agitation\/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU","volume":"46","author":"Devlin","year":"2018","journal-title":"Crit Care Med"},{"key":"B34","doi-asserted-by":"publisher","first-page":"268","DOI":"10.3390\/medicina58020268","article-title":"The relationship between perioperative blood transfusion and postoperative delirium in patients undergoing spinal fusion surgery: clinical data warehouse analysis","volume":"58","author":"Kwon","year":"2022","journal-title":"Medicina (B Aires)"},{"key":"B35","doi-asserted-by":"publisher","first-page":"106063","DOI":"10.1016\/j.ijsu.2021.106063","article-title":"Risk factors for postoperative delirium: an umbrella review of systematic reviews","volume":"93","author":"Bramley","year":"2021","journal-title":"Int J Surg"},{"key":"B36","doi-asserted-by":"publisher","first-page":"755","DOI":"10.1001\/jamasurg.2019.1153","article-title":"Guidelines for perioperative care in cardiac surgery: enhanced recovery after surgery society recommendations","volume":"154","author":"Engelman","year":"2019","journal-title":"JAMA Surg"},{"key":"B37","author":"Mahanna-Gabrielli","year":"2022"},{"key":"B38","doi-asserted-by":"publisher","first-page":"S175","DOI":"10.1161\/CIRCULATIONAHA.112.000327","article-title":"Stroke and outcomes in patients with acute type A aortic dissection","volume":"128","author":"Bossone","year":"2013","journal-title":"Circulation"},{"key":"B39","doi-asserted-by":"crossref","first-page":"S45","DOI":"10.1161\/CIRCULATIONAHA.113.007117","article-title":"Predicting in-hospital mortality in acute type B aortic dissection: evidence from international registry of acute aortic dissection","volume":"130","author":"Tolenaar","year":"2014","journal-title":"Circulation"}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2022.986185\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,11,16]],"date-time":"2022-11-16T11:25:47Z","timestamp":1668597947000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2022.986185\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,8]]},"references-count":39,"alternative-id":["10.3389\/fsurg.2022.986185"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2022.986185","relation":{},"ISSN":["2296-875X"],"issn-type":[{"value":"2296-875X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,9,8]]},"article-number":"986185"}}