Association of preoperative neutrophil‐to‐lymphocyte ratio with the risk of postoperative delirium in elderly patients undergoing noncardiac surgery: a systematic review and meta‐analysis
Why this work is in the frame
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Bibliographic record
Abstract
To assess the correlation between preoperative neutrophil-to-lymphocyte ratio (NLR) and risk of postoperative delirium (POD) in older patients undergoing noncardiac surgery. PubMed, Web of Science, Embase, and Scopus were systematically retrieved from inception until February 2023. Two authors independently conducted the selection of literature, data extraction and statistical analysis. In this meta-analysis, Review Manager 5.4 was used for statistical analysis, and the mean difference (MD) and 95% confidence intervals (CIs) of preoperative NLR between the POD group and non-POD group were calculated. We utilised the Newcastle-Ottawa Scale (NOS) to evaluate the quality of literature. Further, our meta-analysis used a random-effects model, and publication bias was evaluated by conducting a funnel plot. The correlation between preoperative NLR and POD was the primary outcome, and the secondary outcome was the association of other prognostic factors with the risk of POD. This meta-analysis included seven studies with 2424 patients, of whom 403 were diagnosed with POD with an incidence of 16.63%. Results indicated a positive correlation between preoperative NLR and the risk of POD (MD = 1.06, 95% CI: 0.64-1.49; P < 0.001). Further, our results found that neutrophil counts, advanced age, longer surgery time, diabetes, and elevated C-reactive protein were significantly associated with POD (MD = 0.98, 95% CI: 0.40-1.56; P = 0.001; MD = 4.20, 95% CI: 2.90-5.51; P < 0.001; MD = 0.15, 95% CI: 0.05-0.25; P < 0.01; OR = 1.42, 95% CI: 1.08-1.86; P = 0.01; MD = 1.26, 95% CI: 0.36-2.16; P < 0.01). Other factors including lymphocyte counts, hypertension and male gender were not significantly associated with POD (MD = -0.11, 95% CI: -0.27 to 0.05; P > 0.05; OR = 1.20, 95% CI: 0.91-1.58, P > 0.05; OR = 1.28, 95% CI: 1.00-1.63; P = 0.05). Our meta-analysis indicated a positive correlation between preoperative NLR and the risk of POD in older noncardiac surgery patients.
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.008 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.008 | 0.002 |
| Bibliometrics | 0.001 | 0.005 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it