Naples Prognostic Score for Predicting Postoperative Delirium

Naples Prognostic Score for Predicting Postoperative Delirium in the Elderly Undergoing Hip Fracture Surgeries

Naples Prognostic Score (NPS) originally developed to predict outcomes in inflammatory and malignant conditions; we asked if it can effectively predict postoperative delirium (POD) in elderly patients undergoing hip surgery? NPS integrate markers such as albumin, neutrophil-to-lymphocyte ratio, and lymphocyte-to-monocyte ratio-all of which have been linked to adverse postoperative outcomes including POD.

Study Overview

• Status: Recruiting
• Conditions: Postoperative Delirium

Detailed Description

Delirium is a state of acute cerebral dysfunction that manifests as fluctuations in mental status. It is a common problem among all patients admitted to the hospital and has the potential to significantly alter patients' clinical outcomes. There are many risk factors that predispose patients to delirium including age, frailty, and preexisting comorbid conditions, as well as risk factors unique to the perioperative period, such as severity of concurrent illness, type of operation, and ICU admission after surgery (3). Postoperative delirium (POD) should be of paramount importance to providers, as multiple studies in perioperative patients have found significant associations between development of delirium within the first few days of surgery and increased length of stay, higher cost of care, increased hospital readmission rates, higher likelihood of discharge to institution, prolonged cognitive impairment and dementia, and increased mortality (4) (5) . POD occurs commonly but underdiagnosed, and is associated with worse patient outcomes.

Postoperative delirium known as a common and serious complication in elderly surgical patients, particularly after orthopedic surgeries, incidences ranging typically from 5%% up to 48%, with some reports citing rates as high as 70-80% in high-risk geriatric populations (12) . Recent literature showed a strong association between levels of nutritional parameters such as serum albumin (Alb) and lipids and an increased risk of POD (7).However, it is important to note that the prognostic power of a single marker of inflammation or nutritional index might be influenced by variations in physical conditions and the surrounding environment (8). Accordingly, the concept of using a compound indicator of nutrition state and inflammation, known as NPS, presented a novel idea for predicting POD Over the last few years, the NPS was widely used to evaluate the prognosis of cancer patients. Miyamoto et al. pointed out that the NPS was a valuable predictor for postoperative harmful outcomes in patients who underwent colorectal cancer ( CRC) and gastric cancer (GC) surgeries (9).

Because NPS combine inflammatory and nutritional indices, they may provide a more robust and easily measurable means of identifying patients at risk for POD. A preoperative tool based on these scores could enable early intervention, tailored perioperative care, and improved outcomes in this vulnerable population

• Study Type: Observational
• Enrollment (Estimated): 168

Contacts and Locations

• Study Contact: Name: Zeinab M Sayed, MD; Phone Number: +201009071365; Email: zeinab5aton@gmail.com

Study Locations

• Egypt
  • Qena Governorate
    • Qina, Qena Governorate, Egypt, 83511
      • Recruiting
      • Qena University
      • Contact: ZAINAB MOSTAFA; Phone Number: 01009071365; Email: zeinab5aton@gmail.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

elderly patients undergoing Hip fracture surgery

Description

Inclusion Criteria:

• The elderly age≥60 years
• American Society of Anesthesiologists (ASA) classification II∼IV
• Patients undergoing hip fracture surgery
• Patients who had a complete blood sample were taken preoperatively

Exclusion Criteria:

• Patient refused to participate and consent
• Patients with a history of mild cognitive impairment (MCI), dementia, and delirium
• Ptients with known preoperative infections (pulmonary infection, urinary infection, and sepsis).

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort
hip group; patients undergoing hip surgeries will be screened for delirium in the Post-Anesthesia Care Unit (PACU) on arrival, and once daily for the first 3 postoperative days (postoperative days 1 to 3), and on postoperative days 5 and 7.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Assessment of postoperative delirium	Assessment of postoperative deliurim will be done once daily by using an established screening instrument (The Confusion Assessment Method (CAM)). A positive CAM requires both (1) Acute onset & fluctuating course AND (2) Inattention, plus (3) Disorganized thinking OR (4) Altered level of consciousness.	on arrival to PACU, on postoperative day 1, 2, 3, 5, 7.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Length of hospital stay	Determine the duration of hospital stay for geriatric hip fracture patients in our hospital.	Directly before patients' discharge from hospital

Collaborators and Investigators

• Sponsor: South Valley University

Study record dates

Study Major Dates

• Study Start (Actual): January 10, 2026
• Primary Completion (Estimated): June 1, 2027
• Study Completion (Estimated): December 1, 2027

Study Registration Dates

• First Submitted: November 25, 2025
• First Submitted That Met QC Criteria: December 8, 2025
• First Posted (Actual): December 22, 2025

Study Record Updates

• Last Update Posted (Actual): May 14, 2026
• Last Update Submitted That Met QC Criteria: May 13, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: elderly; geriatric; POD; NPS
• Additional Relevant MeSH Terms: Neurologic Manifestations; Nervous System Diseases; Mental Disorders; Postoperative Complications; Pathologic Processes; Confusion; Neurobehavioral Manifestations; Neurocognitive Disorders; Delirium; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Emergence Delirium
• Other Study ID Numbers: ِAIP003-7

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No