Development and validation of a prognostic scoring system for 1-year mortality in older patients with hip fractures

医学 接收机工作特性 髋部骨折 逻辑回归 内科学 体质指数 回顾性队列研究 恶性肿瘤 外科 骨质疏松症
作者
Yusei Katsuyama,Naoyuki Horie,Kengo Yoshii,Shinichiro Nakamura,Tomoki Saito,Kenji Takahashi
出处
期刊:Age and Ageing [Oxford University Press]
卷期号:53 (9)
标识
DOI:10.1093/ageing/afae195
摘要

Abstract Background Hip fractures in older people result in increased mortality. Objective We developed and validated an accurate and simple prognostic scoring system for hip fractures that can be used preoperatively. Design Retrospective study. Setting Multicenter. Participants Patients aged ≥65 years with hip fractures who underwent surgery between 2011 and 2021 were enrolled. Methods The significant factors were determined with logistic regression analysis, and a scoring system was developed. The patients were classified into three groups, and a log-rank test was performed to evaluate 1-year survival rates. The model was internally and externally validated using the 5-fold cross-validation and data from another hospital, respectively. Results We included 1026 patients. The analysis revealed eight significant prognostic factors: sex, body mass index, history of chronic heart failure and malignancy, activities of daily living (ADLs) before injury, hemoglobin and the prognostic nutritional index (PNI) at injury, and the American Society of Anesthesiologists Physical Status. The area under the receiver operating characteristic curve (AUC) after internal validation was 0.853. The external validation data consisted of 110 patients. The AUC of the model for the validation data was 0.905, showing outstanding discrimination. Sensitivity and specificity were 88.7% vs. 100% and 93.3% vs. 95.2% for the development and validation data, respectively. Conclusions We developed and validated an accurate and simple prognostic scoring system for hip fractures using only preoperative factors. Our findings highlight PNI as an important predictor of prognosis in hip fracture patients.

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