老年髋部骨折患者术后1年内死亡的影响因素分析及列线图预测模型构建  

Influencing factors of 1-year postoperative mortality in elderly with hip fracture and construction of a nomogram prediction model

作　　者：杨昌凤 何永琴 易德坤 李玉 赖淋雨 张玉梅 YANG Changfeng;HE Yongqin;YI Dekun;LI Yu;LAI Linyu;ZHANG Yumei(Department of Orthopedics,Second Affiliated Hospital,Army Medical University(Third Military Medical University),Chongqing,400037,China)

机构地区：[1]陆军军医大学(第三军医大学)第二附属医院骨科,重庆400037

出　　处：《陆军军医大学学报》2023年第1期60-66,共7页Journal of Army Medical University

基　　金：陆军军医大学护理创新基金(2020m09)。

摘　　要：目的 探讨基于营养学新评价指标的老年髋部骨折患者术后1年死亡的影响因素,并根据危险因素绘制列线图,预测老年髋部骨折患者1年死亡风险。方法 回顾性分析2018年1月至2021年5月行手术治疗且获得随访的457例老年髋部骨折患者,记录患者基线资料、MNA评分、NRS2002评分、APACHEⅡ评分、血清营养学指标、人体成分分析指标等营养学新评价指标资料,以1年内死亡为观察结局。采用多因素Logistic回归模型分析老年髋部骨折患者术后1年内死亡的独立危险因素,进一步采用R Studio软件构建预测老年髋部骨折患者术后1年死亡风险的列线图模型。结果 术后1年内共52例患者死亡,病死率为11.38%。共存疾病≥3种、年龄、CRP水平是老年髋部骨折患者术后1年内死亡的独立危险因素[OR及95%CI分别为3.196(1.107~9.226)、1.152(1.083~1.225)、1.013(1.004~1.022),P<0.05],BMI、骨骼肌含量是保护因素[OR及95%CI分别为0.766(0.671~0.874)和0.782(0.726~0.842),P<0.05];基于以上5个影响因素绘制列线图,并进行内部验证,结果显示模型区分度C-index指数及95%CI分别为0.92(0.870~0.970),校正曲线提示模型一致性良好,说明列线图模型具有较好的预测能力。结论 年龄、CRP、BMI、共存疾病≥3种、骨骼肌含量是老年髋部骨折患者术后1年死亡的独立影响因素。列线图模型对预测老年髋部骨折患者术后1年死亡风险具有一定作用。Objective To investigate the influencing factors of 1-year postoperative mortality in elderly patients with hip fracture based on new nutritional indicators, and draw a predictive nomogram for 1-year death in these elderly patients. Methods A retrospective study was conducted on 457 elderly hip fracture patients who underwent surgical treatment in our department from January 2018 to May 2021. All of them were followed up, and the outcomes in 1 year after operation were observed. Their baseline data, mini-nutritional assessment(MNA) score, nutritional risk screening 2002(NRS2002) score, acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) score, serum nutritional indicators, body compositions and other new nutritional indicators were collected and analysis with 1-year mortality as observation outcome. Multivariate logistic regression analysis was used to analyze the independent risk factors of 1-year postoperative death in these elderly patients, and further R Studio software was applied to build a nomograph model to predict the risk of death. Results Of 457 elderly patients with hip fracture, 52(11.38%) died within 1 year after operation and 405 survived. More than 3 comorbidities, age, and C-reactive protein(CRP) level were independent risk factors [OR(95%CI): 3.196(1.107~9.226), 1.152(1.083~1.225), 1.013(1.004~1.022), P<0.05], and BMI and skeletal muscle content were protective factors [OR(95%CI): 0.766(0.671~0.874), 0.782(0.726~0.842), P<0.05] for death within 1 year after surgery in elderly patients with hip fracture. Based on the above 5 influencing factors, a column graph was drawn and assessed with internal verification. The results showed that the C-index of model differentiation and 95%CI was 0.92 and 0.870~0.970, respectively. The correction curve indicated that the model had good consistency, indicating that the column graph model had good predictive ability. Conclusion Age, CRP, BMI, ≥3 comorbidities and skeletal muscle content are independent risk factors for death within 1 year after hip

关 键 词：老年人 髋部骨折 年病死率 营养评价 影响因素 列线图模型 

分 类 号：R195.4[医药卫生—卫生统计学] R339.34[医药卫生—卫生事业管理] R683.3[医药卫生—公共卫生与预防医学]