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. 2024 Sep 5;24(1):739.
doi: 10.1186/s12877-024-05334-1.

Exploring the role of calf circumference as a predisposing factor for intra-hospital delirium: investigating potential gender differences: revealing potential gender variances

Chiara Ceolin  1   2 , Mario Virgilio Papa  3 , Cristina Simonato  3 , Sara Cazzavillan  3 , Margherita Vergadoro  4 , Giulia Salerno Trapella  3 , Riccardo Sermasi  3 , Marina De Rui  3 , Marianna Noale  5 , Bruno Micael Zanforlini  3 , Chiara Curreri  3 , Anna Bertocco  3 , Maria Devita  3   6 , Giuseppe Sergi  3 , Alessandra Coin  3
Affiliations

Exploring the role of calf circumference as a predisposing factor for intra-hospital delirium: investigating potential gender differences: revealing potential gender variances

Chiara Ceolin et al. BMC Geriatr. .

Abstract

Background: Malnutrition and sarcopenia significantly increase the risk of intra-hospital delirium, particularly among older adults. Given the potential correlation between calf circumference (CC) and these conditions, CC emerges as a promising predisposing factor for delirium. This study aims to investigate the independent association between delirium and anthropometric parameters, focusing on evaluating CC's predictive capacity for intra-hospital delirium risk. Additionally, it aims to compare CC's predictive performance with the widely used Mini Nutritional Assessment (MNA), while also considering potential gender disparities.

Methods: This is a retrospective study which enrolled patients aged ≥ 65 years from September 2021 to March 2022 at the Padova Hospital (Italy). Physical characteristics, intra-hospital delirium incidence, and body composition were assessed. Sarcopenia was diagnosed using the 2019 European Consensus criteria.

Results: Among 207 subjects, delirium affected 19% of patients. CC showed a significant association with intra-hospital delirium among the analyzed anthropometric parameters. ROC curves indicated that CC's predictive capacity for delirium onset was comparable to MNA (p = 0.98), particularly in women. In a multivariable logistic regression model, female gender and higher cognitive and CC scores emerged as protective factors against delirium onset, with each unit increase in CC associated with a 24% reduction in the odds of delirium. Conversely, sarcopenia did not significantly influence delirium onset.

Conclusions: CC shows promise as a predisposing factor for intra-hospital delirium, similar to MNA, albeit with significant gender differences. CC could serve as a valuable tool for assessing delirium risk among female patients. Further validation of these findings is necessary through larger-scale studies.

Keywords: Calf circumference; Delirium; Nutritional status; Older adults; Sarcopenia.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Simple correlations between anthropometric and body composition parameters and delirium, by gender. The Figure displays a heatmap representing, through color intensity, the correlations between delirium presence and anthropometric parameters. The only positive correlations are observed between delirium and calf circumference (CC) in both women and men (p < 0.05). In women, fat mass index (FMI) is also significantly associated with the presence of delirium. Abbreviations MUAC = Mid-Upper Arm Circumference; CC = Calf Circumference; BMI = Body Mass Index; ASMMI = Appendicular Skeletal Muscle Mass Index; FM = Fat Mass INdex; *p-values < 0.05 (only referred to delirium correlation)
Fig. 2
Fig. 2
ROC curves for MNA and calf circumference in relation to delirium development. The ROC curve compares calf circumference (CC) and Mini Nutritional Assessment (MNA) in relation to delirium development. It illustrates the diagnostic performance of each measure by plotting the true positive rate (sensitivity) against the false positive rate (1-specificity) at various threshold levels. A higher area under the curve (AUC) indicates better overall accuracy in predicting delirium. This comparison helps to determine which measure is more effective in identifying patients at risk for delirium. Abbreviations CC = Calf Circumference; MNA = Mini Nutritional Assessment
See this image and copyright information in PMC

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