Cardiothoracic & vascular anaesthesia
Estimated Pulse Wave Velocity, Early Postoperative Neutrophil to Lymphocyte Ratio, and Delirium After Cardiac Surgery: A Retrospective Cohort Study Using the Medical Information Mart for Intensive Care IV Database
Authors' conclusion
Higher ePWV and early postoperative NLR were associated with strict CAM-ICU-detected POD. However, ePWV represents an age- and blood pressure-derived composite index, and the incremental discrimination provided by both markers beyond clinical and perioperative factors was limited.
Study context
- Population
- Adults undergoing open cardiac surgery in a cardiac surgical intensive care unit (ICU) cohort (MIMIC-IV) with available estimated pulse wave velocity (ePWV), postoperative 0- to 24-hour neutrophil to lymphocyte ratio (NLR) and evaluable Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) assessments
- Participants
- 5,684 adults
- Exposure
- Per 1-SD increase in estimated pulse wave velocity (ePWV) and per doubling of early postoperative neutrophil to lymphocyte ratio (NLR)
- Outcome
- Strict CAM-ICU-detected POD, excluding assessments during deep sedation
Methodological detailsMIMIC-IV database, multivariable logistic regression, multiple imputation
- MIMIC-IV database
- Multivariable logistic regression
- Multiple imputation
Main finding
As reported in the abstract
POD
Odds ratio (95% CI)P value
Each 1-SD increase in ePWV
1.46(1.06–2.02)
P = 0.021Each doubling of NLR
1.15(1.06–1.25)
P = 0.001Each row per its own increment, as printed
- Postoperative delirium (POD) incidence
- 1,001 (17.6%)
Observational data: associations, not effects.
Further findings
| Outcome | Change in AUC (95% CI) |
|---|---|
| Incremental discrimination of adding both markers to reference model (apparent AUC)Reference model + ePWV + NLR vs Reference model · AUC 0.790 to 0.791 | 0.0016 (−0.0006 to 0.0037) |
Sensitivity analyses
- Findings generally consistent across sensitivity analyses
Original publication
Estimated Pulse Wave Velocity, Early Postoperative Neutrophil to Lymphocyte Ratio, and Delirium After Cardiac Surgery: A Retrospective Cohort Study Using the Medical Information Mart for Intensive Care IV Database. J Cardiothorac Vasc Anesth. Published 29 August 2026. doi:10.
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