Nomogram for Prediction of Postoperative Delirium after Deep Brain Stimulation of Subthalamic Nucleus in Parkinson’s Disease under General Anesthesia

Table 1

Baseline characteristics and univariate analysis of postoperative delirium in PD patients after STN-DBS under general anesthesia.

	Total population	Nondelirium group	Delirium group	value
	n = 159	n = 121	n = 38
General information
Age (years)	59.65 ± 8.83	59.17 ± 8.92	61.21 ± 8.44	0.21
> 65 years	51 (32.08)	36 (29.75)	15 (39.47)	0.27
Male sex	106 (66.67)	81 (66.94)	25 (65.79)	0.90
Body mass index (kg/m^2)	23.02 ± 3.30	23.02 ± 3.34	23.03 ± 3.24
Normal (18.5–23.9)	73 (45.91)	50 (41.32)	23 (60.53)	0.12
Low (<18.5)	20 (12.58)	17 (14.05)	3 (7.89)	0.07
High (>23.9)	66 (41.51)	54 (44.63)	12 (31.58)	0.74
Smoking (current/former)	24(15.09)	14(11.57)	10(26.32)	0.03
Hypertension	41 (25.79)	32 (26.45)	9 (23.68)	0.73
Diabetes	12 (7.55)	10 (8.26)	2 (5.26)	0.55
Cardiac disease	15 (9.43)	8 (6.61)	7 (18.42)	0.04
Surgical history	81 (50.94)	62 (51.24)	19 (50.00)	0.89
History of delirium	4 (2.52)	1 (0.83)	3 (7.89)	0.05
History of drug-induced hallucination	34 (21.38)	21 (17.36)	13 (34.21)	0.03
Age at onset of PD (years)	50.31 ± 8.86	49.63 ± 8.93	52.47 ± 8.40	0.18
≥60	22 (13.84)	15 (12.40)	7 (18.42)
50–59	71 (44.65)	52 (42.98)	19 (50.00)
40–49	46 (28.93)	38 (31.40)	8 (21.05)
≤39	20 (12.58)	16 (13.22)	4 (10.53)
Duration of PD over 10 (years)	69 (43.40)	54 (44.63)	15 (39.47)	0.58
First affected extremity
Left side	73 (45.91)	56 (46.28)	17 (44.74)	0.90
Right side	76 (47.80)	58 (47.93)	18 (47.37)	0.64
Both sides or head or neck	10 (6.29)	7 (5.79)	3 (7.89)	0.66
Hoehn and Yahr stage (off)	3.13 ± 0.71	3.16 ± 0.71	3.04 ± 0.70	0.36
Hoehn and Yahr stage (on)	2.14 ± 0.66	2.15 ± 0.66	2.11 ± 0.65	0.75
Preoperative motor assessments
Levodopa challenge test (%)	62.11 ± 13.13	62.94 ± 12.74	59.38 ± 14.19	0.41
MDS-UPDRS III >66, off	27 (16.98)	22 (18.18)	5 (13.16)	0.47
Clinical phenotypes of motor impairment
Tremor domination	88 (55.35)	67 (55.37)	21 (55.26)	0.99
Postural/gait difficulty	58 (36.48)	44 (36.36)	14 (36.84)	0.95
Indeterminate	13 (8.18)	10 (8.26)	3 (7.89)	0.94
Preoperative nonmotor assessments
MMSE score	27.70 ± 2.25	27.88 ± 2.19	27.11 ± 2.37	0.07
ESS score	7.42 ± 5.26	7.17 ± 4.97	8.21 ± 6.09	0.50
RBD	65 (40.88)	47 (38.84)	18 (47.37)	0.35
HAMA score	6.67 ± 5.78	5.89 ± 5.16	9.16 ± 6.91	<0.01
<8, normal	95 (59.75)	79 (65.29)	16 (42.11)
8–14, anxiety, may be	46 (28.93)	32 (26.45)	14 (36.84)
15–21, anxiety (mild)	14 (8.81)	8 (6.61)	6 (15.79)
>21, anxiety (moderate/severe)	4 (2.52)	2 (1.65)	2 (5.26)
HAMD score	8.84 ± 6.24	8.28 ± 5.83	10.61 ± 7.18	0.11
<8, normal	84 (52.83)	66 (54.55)	18 (47.37)
8–20, suspicious depression	64 (40.25)	50 (41.32)	14 (36.84)
>20, depression	11 (6.92)	5 (4.13)	6 (15.79)
Orthostatic hypotension	13 (8.18)	6 (4.96)	7 (18.42)	0.01
Preoperative laboratory and MRI examination
Hypoproteinemia	11 (6.92)	6 (4.96)	5 (13.16)	0.09
Plasma APOE level (mg/L)
Normal (27–45)	93 (58.49)	77 (63.64)	16 (42.11)	0.04
Low (<27)	11 (6.92)	6 (4.96)	5 (13.16)	0.06
High (>45)	55 (34.59)	38 (31.40)	17 (44.74)	0.36
Brain atrophy	73 (45.91)	56 (46.28)	17 (44.74)	0.87
Silent brain infarction/ischemia	102 (64.15)	72 (59.50)	30 (78.95)	0.03
Preoperative medication
LEDD > 1000 mg	38 (23.90)	28 (23.14)	10 (26.32)	0.69
Amantadine	22 (13.84)	14 (11.57)	8 (21.05)	0.15
COMT inhibitors	79 (49.69)	62 (51.24)	17 (44.74)	0.49
MAOBIs	31 (19.50)	18 (14.88)	13 (34.21)	0.01
Antipsychotics	19 (11.95)	14 (11.57)	5 (13.16)	0.79
Hypnotics	57 (35.85)	45 (37.19)	12 (31.58)	0.53
Anesthesia and surgery
Anesthesia time > 420 min	63 (39.62)	44 (36.36)	19 (50.00)	0.14
Use of etomidate	32 (20.13)	19 (15.70)	13 (34.21)	0.02
Intraoperative hypotension	2 (1.26)	1 (0.83)	1 (2.63)	0.41
MAP (mmHg)	78.76 ± 6.70	78.21 ± 6.87	80.53 ± 5.83	0.07
SAP (mmHg)	114.94 ± 8.92	114.33 ± 8.56	116.90 ± 9.84	0.12
Use of dexamethasone	109 (68.55)	90 (74.38)	19 (50.00)	0.01

Numbers indicate means ± standard deviations (SD) or number (percentage). Differences between the nondelirium group and delirium group were analyzed using univariate logistic regression analysis. Significance was recognized when . PD, Parkinson’s disease; STN, subthalamic nucleus; DBS, deep brain stimulation; MDS-UPDRS III, part 3 motor examination of the Movement Disorder Society Unified Parkinson’s Disease Rating Scale; MMSE, mini-mental state examination; ESS, Epworth sleepiness scale; RBD, rapid eye movement sleep behavior disorder; HAMA, Hamilton anxiety scale; HAMD, Hamilton depression scale; MRI, magnetic resonance imaging; APOE, apolipoprotein E; LEDD, levodopa equivalent daily dose; COMT, catechol-O-methyl transferase; MAOBIs, type-B monoamine oxidase inhibitors; MAP, mean arterial pressure; SAP, systolic arterial pressure.