老年髋部骨折术后1年病死率的危险因素分析及年龄矫正查尔森合并指数对其的预测价值  

Risk factor analysis of 1-year mortality after hip fracture in elderly patients and the predictive value of age-corrected Charlson combined index

作　　者：陈晓鹏[1] 何久盛 陈楚鹰 张浩 李林[1] 赵雪东 许渴 廖文利[1] Chen Xiaopeng;He Jiusheng;Chen Chuying;Zhang Hao;Li Lin;Zhao Xuedong;Xu Ke;Liao Wenli(Department of Traumatic Orthopedics,Beijing Shunyi District Hospital,Beijing 101300,China)

机构地区：[1]北京市顺义区医院创伤骨科,101300

出　　处：《骨科临床与研究杂志》2024年第3期176-182,共7页Journal Of Clinical Orthopedics And Research

基　　金：首都卫生发展科研专项(2022-1-2071)。

摘　　要：目的分析影响老年髋部骨折患者手术后1年病死率的危险因素及年龄矫正查尔森合并指数对其的预测价值。方法回顾性分析2018年1月至2022年11月在北京市顺义区医院创伤骨科行髋部骨折手术治疗的老年患者的病历资料,符合纳入标准共652例,收集年龄、性别、骨折侧别、骨折类型、美国麻醉医师协会(ASA)分级、住院天数、麻醉方式、术后白蛋白、术后白细胞、术后血红蛋白、年龄矫正查尔森合并指数(ACCI)和是否发生肺炎等信息,分析与患者1年病死率相关的危险因素。结果652例患者术后1年的病死率为21.5%(140/652)。单因素Cox回归分析显示年龄、住院时间、ACCI及术后是否发生肺炎与术后1年病死率有统计学意义。多因素Cox回归分析显示年龄(HR=1.087,95%CI:1.060~1.114,P=0),ACCI(HR=1.645,95%CI:1.548~1.747,P=0),术后发生肺炎(HR=2.353,95%CI:1.624~3.408,P=0)是老年髋部骨折患者1年内死亡的危险因素。ACCI预测老年髋部骨折患者术后1年病死率的AUC为0.912,最佳阈值为5.5时的特异度为0.834,敏感度为0.871。结论年龄、ACCI、术后发生肺炎时老年髋部骨折术后1年死亡的独立危险因素,ACCI对预测老年髋部骨折术后1年病死率有一定价值,可为临床病情评估提供方法。Objective To investigate the risk factors for mortality within one year after surgery in elderly patients with hip fracture,as well as to examine the relationship between age-corrected Charlson combined index and the mortality rate at first year in these patients.Methods The clinical data of the elderly patients who needed a surgery for hip fracture in the Department of Traumatic Orthopedics in Beijing Shunyi District Hospital from January 2018 to November 2022 were retrospectively analyzed.According to the inclusion criteria of the study,652 cases were included.Then the information for patients including age,sex,surgery side,type of fracture,American Society of Anesthesiologists(ASA)score,length of hospital stay,type of anesthesia,postoperative albumin,postoperative white blood cells,postoperative hemoglobin,age-corrected Charlson combined index and postoperative pneumonia were collected.Univariate and multivariate Cox regression analyses were conducted to investigate the factors related to one-year mortality of patients.Results 652 patients in this cohort study had a mortality rate of 21.5%(140/652)at 1 year after surgery.Univariate Cox regression analysis showed that age,length of hospital stay,age-corrected Charlson combined index and postoperative pneumonia correlated with one-year mortality after surgery.Further,multivariate Cox regression analysis revealed that age(HR=1.087,95%CI:1.060~1.114,P=0),age-corrected Charlson combined index(HR=1.645,95%CI:1.548~1.747,P=0)and postoperative pneumonia(HR=2.353,95%CI:1.624~3.408,P=0)were risk factors for one-year mortality.The results of ROC curve showed that the AUC,specificity,sensitivity and optimal threshold of age-corrected Charlson combined index in predicting the one-year mortality of elderly hip fracture patients after surgery were 0.912.When the optiornal threshold was 5.5,the degree of specifity was 0.834 and the sensitivity was 0.871.Conclusion Age,age-corrected Charlson combined index and postoperative pneumonia are independent risk factors for patients w

关 键 词：老年人 髋骨折 术后1年死亡率 年龄矫正查尔森合并指数 

分 类 号：R683.4[医药卫生—骨科学]