A correlational study of plasma galectin-3 as a potential predictive marker of postoperative delirium in patients with acute aortic dissection

Abstract

This study aimed to demonstrate whether plasma galectin-3 could predict the development of postoperative delirium (POD) in patients with acute aortic dissection (AAD). Prospective, observational study. Cardiac surgery intensive care unit. Consecutive patients who were diagnosed with AAD and operated at the Cardiac Medical Center of Fujian Province between December 2020 and December 2022. Patients were classiffed into two groups according to the Confusion Assessment Method for the Intensive Care Unit: POD group and NON-POD group. Each patient's plasma was tested before emergency surgery. Baseline demographic data and preoperative, intraoperative, and postoperative clinical data were collected. The short-term clinical outcomes were followed up daily. The rate of POD was calculated. The risk factors for POD were analyzed through univariate analysis and multivariate logistic regression. Receiver operating characteristic (ROC) curves were used to assess the ability of plasma galectin-3 to predict POD. A total of 309 study subjects were included in this study, and the rate of POD was 38.8%. Patients with AAD were categorized into the POD and NON-POD cohorts postoperatively based on their CAM-ICU scores. There was no statistically significant difference in the baseline characteristics between the two groups (P > 0.05). However, patients in the POD group had significantly elevated plasma galectin-3 levels (P < 0.001). The ROC curves showed that plasma galectin-3 had a sensitivity of 72.5% and a specificity of 70.9% as a potential biomarker for the diagnosis of POD. The critical value of plasma galectin-3 for diagnosing POD was 9.18 ng/mL. Plasma galectin-3 levels remained an independent predictor of POD after controlling for different variables (P < 0.001). Elevated plasma galectin-3 levels are associated with an increased risk of POD. Plasma galectin-3 may be a prospective biomarker for predicting POD.

Keywords: Aortic dissection; Galectin-3; Postoperative delirium.

Fig. 1

Patients’ flowchart of the study.

Fig. 2

Relationship plasma galectin-3 level and POD. (A) The violin chart showed that plasma galectin-3 levels were compared between NON-POD group and POD group. The white dots show the median and the difference was tested by Mann–Whitney U test, p < 0.01. (B) Incidence of POD in subgroups divided by galectin-3 level quartiles. Q1, ≤ 4.24 ng/ml; Q2, 4.24–8.17 ng/ml; Q3, 8.17–15.23 ng/ml; Q4, ≥ 15.23 ng/ml.

Fig. 3

Feature selection was performed using the Minimum Absolute shrink and selection operator (LASSO) binary logistic regression model. (A) The adjustment parameter (λ) in the LASSO model is selected by minimum criteria using 10 × cross-validation. The relationship between the area under the subject operating characteristic (AUC) curve and log (λ) is plotted. Draw a vertical dotted line at the best value using 1 standard error of the minimum standard and the minimum standard (1-SE standard). According to tenfold cross-validation, the standard error of the minimum distance λ is 0.058. (B) Lasso coefficient profile for each texture feature. Generate coefficient profiles from logarithmic (λ) sequences. A vertical line is drawn at the selected value using × 10 cross validation, where the best λ yields 6 filter variables.

Fig. 4

ROC curve analysis of plasma galectin-3 prediction of POD.