A nomogram incorporating CONUT and HS-mGPS predicts delirium after hip fracture in elders

Abstract Postoperative delirium (POD) is a common complication in elderly patients following hip fracture surgery, with malnutrition considered a potential risk factor. This study aimed to investigate the association between preoperative nutrition-related indicators and the occurrence of POD in this patient population. This retrospective cohort study included 532 patients from January 2018 to June 2024. Clinical and laboratory data were retrospectively collected. Risk factors were identified using LASSO, univariate, and multivariate logistic regression analyses in the training cohort. A nomogram model was developed and its accuracy assessed using calibration plots. The clinical utility of the nomogram was evaluated through decision curve analysis (DCA) and validated internally within the training set. Of the 532 patients, 74 experienced POD, resulting in an incidence rate of 13.91%. Preoperative Controlling Nutritional Status (CONUT) score and High-sensitive Modified Glasgow Prognostic Score (HS-mGPS) were identified as independent risk factors for POD in the training cohort. The nomogram model, developed based on multivariate logistic analyses, achieved an area under the curve (AUC) of 0.965 (95% CI 0.929–1.000) in the training cohort and 0.884 (95% CI 0.739–1.000) in the validation cohort. The calibration curve indicated that the predicted probability aligned well with the actual probability. DCA demonstrated that the nomogram model provided net benefits for predicting POD in elderly patients following hip fracture surgery. Nutrition-related indicators, specifically CONUT and HS-mGPS, were identified as independent predictors of POD in elderly patients after hip fracture surgery.