The Relationship Between Cardiovascular Disease Risk Score and Postoperative Delirium: The PNDABLE Study

Objective: We aimed to investigate the relationship between Framingham Heart Study general cardiovascular disease risk score (FHS-CVD risk score) and postoperative delirium (POD) among patients who had unilateral total knee arthroplasty performed under epidural anesthesia. Furthermore, we examined whether such a hypothesised relationship was mediated by the cerebrospinal fluid (CSF) biomarkers. Methods: A total of 750 participants were included in the current study. And the data was drawn from the database obtained from the Perioperative Neurocognitive Disorder And Biomarker Lifestyle (PNDABLE) study. Linear regression analysis was performed to examine the relationship between FHS-CVD risk score and the POD CSF biomarkers. Logistic regression was used to analyze the relationship between FHS-CVD risk score, POD CSF biomarkers and POD incidence. The proposed mediating effect of CSF biomarker was evaluated using Mediation analysis with 10,000 bootstrapped iterations. The receiver operating characteristic (ROC) curve is chosen as the evaluation metric for assessing the efficacy of FHS-CVD risk score in predicting POD. Results: In the PNDABLE study, the overall incidence of POD was 22.9%, with 37.2% in the higher vascular risk group and 7.9% in the lower vascular risk group. Multiple linear regression models showed that higher preoperative FHS-CVD risk score were positively correlated with CSF T-tau (β = 0.218, P=0.015) and P-tau level (β = 0.309, P