Peer-Reviewed Publication
Br J Anaesth2026;136(5):1495-1508.May 1, 2026Journal Article
Prediction and risk evaluation of delirium after surgery in older patients: development and internal validation of an algorithm from the prospective BioCog cohort study.
Florian Lammers-Lietz1, Levent Akyuez2, Diana Boraschi3, Friedrich Borchers4, Jeroen de Bresser5, Sreyoshi Chatterjee6, Marta M Correia7, Nikola M de Lange8, Thomas Bernd Dschietzig9, Soumyabrata Ghosh8, Insa Feinkohl10, Izabela Ferreira da Silva8, Marinus Fislage4, Anna Fournier11, Jürgen Gallinat12, Daniel Hadzidiakos4, Sven Hädel13, Fatima Halzl-Yürek4, Stefanie Heilmann-Heimbach14, Maria Heinrich15, Jeroen Hendrikse16, Per Hoffmann17, Jürgen Janke18, Ilse M J Kant19, Angelie Kraft20, Roland Krause8, Jochen Kruppa-Scheetz21, Simone Kühn22, Gunnar Lachmann15, Markus Laubach23, Christoph Lippert24, David K Menon25, Rudolf Mörgeli4, Anika Müller4, Henk-Jan Mutsaerts26, Markus Nöthen14, Peter Nürnberg27, Kwaku Ofosu4, Malte Pietzsch28, Sophie K Piper29, Tobias Pischon30, Jacobus Preller31, Konstanze Scheurer4, Reinhard Schneider8, Kathrin Scholtz4, Peter H Schreier32, Arjen J C Slooter19, Emmanuel A Stamatakis33, Clarissa von Haefen4, Simone J T van Montfort19, Edwin van Dellen34, Hans-Dieter Volk35, Simon Weber28, Janine Wiebach36, Anton Wiehe37, Jeanne M Winterer38, Alissa Wolf4, Norman Zacharias39, Claudia Spies4, Georg Winterer40,
1Department of Anesthesiology and Intensive Care Medicine-Universitätsmedizin Berlin, Berlin, Germany; Pharmaimage Biomarker Solutions GmbH, Berlin, Germany. Electronic address: florian.lammers@charite.de.
2Berlin Institute of Health at Charité-Universitätsmedizin Berlin, BIH Center for Regenerative therapies (BCRT), and Charité-Universitätsmedizin Berlin, Institute of Medical Immunology, Berlin, Germany; CheckImmune GmbH, Berlin, Germany.
3Institute of Protein Biochemistry, Consiglio Nazionale delle Ricerche (CNR) di Pisa, Pisa, Italy.
4Department of Anesthesiology and Intensive Care Medicine-Universitätsmedizin Berlin, Berlin, Germany.
5Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
6Bioinformatics Core, Luxembourg Center for Systems Biomedicine (LCSB), University of Luxembourg, Belvaux, Luxembourg; Deutsches Zentrum für Luft und Raumfahrt (DLR), Cologne, Germany.
7MRC Cognition and Brain Sciences Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK.
8Bioinformatics Core, Luxembourg Center for Systems Biomedicine (LCSB), University of Luxembourg, Belvaux, Luxembourg.
9Immundiagnostik AG, Bensheim, Germany.
10Molecular Epidemiology Research Group, Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany; Faculty of Health at Department of Medicine, Witten/Herdecke University, North Rhine-Westphalia, Germany.
11Bioinformatics Core, Luxembourg Center for Systems Biomedicine (LCSB), University of Luxembourg, Belvaux, Luxembourg; Swiss Data Science Center (SDSC), ETH Zurich, Zurich, Switzerland.
12Department of Psychiatry, University Medical-Center Hamburg-Eppendorf, Hamburg, Germany.
13Pharmaimage Biomarker Solutions GmbH, Berlin, Germany.
14Institute of Human Genetics, University of Bonn, Bonn, Germany.
15Department of Anesthesiology and Intensive Care Medicine-Universitätsmedizin Berlin, Berlin, Germany; Berlin Institute of Health at Charité-Universitätsmedizin Berlin, BIH Academy, (Digital) Clinician Scientist Program, Berlin, Germany.
16Department of Radiology and Brain Center Rudolf Magnus, University Medical Center Utrecht (UMC), Utrecht, The Netherlands.
17Institute of Human Genetics, University of Bonn, Bonn, Germany; Division of Medical Genetics, University Hospital, Basel, Switzerland; Human Genetics Research Group, Department of Biomedicine, University of Basel, Basel, Switzerland.
18Molecular Epidemiology Research Group, Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany; Biobank Technology Platform, Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany.
19Department of Intensive Care Medicine and Brain Center, University Medical Center Utrecht (UMC), Utrecht University, Utrecht, The Netherlands.
20AdaLab UG, Hamburg, Germany; Pharmaimage Biomarker Solutions Inc., Cambridge, MA, USA.
21Institute of Biometry and Clinical Epidemiology-Universitätsmedizin Berlin, Berlin, Germany; Hochschule Osnabrück, University of Applied Sciences, Osnabrück, Germany.
22Department of Anesthesiology and Intensive Care Medicine-Universitätsmedizin Berlin, Berlin, Germany; Department of Psychiatry, University Medical-Center Hamburg-Eppendorf, Hamburg, Germany.
23Department of Anesthesiology and Intensive Care Medicine-Universitätsmedizin Berlin, Berlin, Germany; Pharmaimage Biomarker Solutions Inc., Cambridge, MA, USA; Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, LMU Munich, Munich, Germany.
24Hasso-Plattner Institute, University of Potsdam, Potsdam, Germany.
25Neurosciences/Trauma Critical Care Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK; Division of Anaesthesia, Department of Medicine, School of Clinical Medicine, University of Cambridge, Cambridge, UK.
26Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands; Amsterdam Neuroscience, Amsterdam, The Netherlands.
27Cologne Center for Genomics, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany; Institute for Genetics of the University of Cologne, Cologne, Germany; Atlas Biolabs GmbH, Berlin, Germany.
28Cellogic GmbH (Cellogic), Berlin, Germany.
29Institute of Biometry and Clinical Epidemiology-Universitätsmedizin Berlin, Berlin, Germany; Institute of Medical Informatics-Universitätsmedizin Berlin, Berlin, Germany.
30Molecular Epidemiology Research Group, Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany; Biobank Technology Platform, Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany; Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Core Facility Biobank, Berlin, Germany.
31Department of Medicine, School of Clinical Medicine, University of Cambridge, Cambridge, UK; John Farman Intensive Care Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
32Pharmaimage Biomarker Solutions Inc., Cambridge, MA, USA; Institute for Genetics of the University of Cologne, Cologne, Germany.
33Division of Anaesthesia, Department of Medicine, School of Clinical Medicine, University of Cambridge, Cambridge, UK; Department of Clinical Neurosciences, School of Clinical Medicine, University of Cambridge, Cambridge, UK.
34Department of Intensive Care Medicine and Brain Center, University Medical Center Utrecht (UMC), Utrecht University, Utrecht, The Netherlands; Department of Psychiatry and UMC Utrecht Brain Center, University Medical Center Utrecht (UMC), Utrecht, The Netherlands.
35CheckImmune GmbH, Berlin, Germany; Institute of Medical Immunology, Charité-Universitätsmedizin Berlin-Universitätsmedizin Berlin, Berlin, Germany.
36Institute of Biometry and Clinical Epidemiology-Universitätsmedizin Berlin, Berlin, Germany; BIH Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Core Unit Metabolomics, Berlin, Germany.
37Pharmaimage Biomarker Solutions GmbH, Berlin, Germany; AdaLab UG, Hamburg, Germany; Pharmaimage Biomarker Solutions Inc., Cambridge, MA, USA.
38Pharmaimage Biomarker Solutions GmbH, Berlin, Germany; Pharmaimage Biomarker Solutions Inc., Cambridge, MA, USA; Department of Psychiatry-Universitätsmedizin Berlin, Berlin, Germany; Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany.
39Department of Anesthesiology and Intensive Care Medicine-Universitätsmedizin Berlin, Berlin, Germany; Pharmaimage Biomarker Solutions Inc., Cambridge, MA, USA; Department of Otorhinolaryngology, Head and Neck Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany.
40Department of Anesthesiology and Intensive Care Medicine-Universitätsmedizin Berlin, Berlin, Germany; Pharmaimage Biomarker Solutions GmbH, Berlin, Germany; Pharmaimage Biomarker Solutions Inc., Cambridge, MA, USA.
Abstract
BACKGROUND: Postoperative delirium (POD) affects ∼20% of older surgical patients. It is associated with poor clinical outcome and increased mortality. We aimed to identify the major POD risk factors and to develop and validate a multivariate algorithm for individual POD risk prediction and risk evaluation in the very early postoperative period.
METHODS: BioCog is a prospective cohort study conduc…
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