老年股骨转子间骨折术后1年死亡风险预测模型的构建和验证  

Development and validation of survival prediction model for one-year mortality after surgery for intertrochanteric fractures in elderly patients

作　　者：宋进良 翁友林 郑富文 李祖涛 蔡昱 王伟 Song Jinliang;Weng Youlin;Zheng Fuwen;Li Zutao;Cai Yu;Wang Wei(Orthopedic Trauma Center of Xinyang People's Hospital,Xinyang 464000,China;Department of Traumatic Orthopedics,People's Hospital of Xinjiang Uygur Autonomous Region,Urumqi 830000,China)

机构地区：[1]信阳市人民医院骨科创伤中心,信阳464000 [2]新疆维吾尔自治区人民医院创伤骨科,乌鲁木齐830000

出　　处：《中华老年医学杂志》2024年第10期1299-1305,共7页Chinese Journal of Geriatrics

摘　　要：目的探讨老年股骨转子间骨折术后1年死亡风险的危险因素,构建生存预测模型。方法回顾性分析2020年1月至2022年9月新疆维吾尔自治区人民医院和信阳市人民医院收治的532例老年股骨转子间骨折患者的临床资料,记录患者的人口特征、实验室指标和手术变量,研究结局为术后1年死亡率。通过单因素和多因素Cox回归分析,筛选危险因素并依此构建预后模型。通过一致性指数(C-Index)、时间依赖性受试者工作特征(ROC)曲线、校准曲线、决策曲线(DCA)来评价模型的预测效能。结果多因素Cox回归分析显示:改良5项衰弱指数(mFi-5)(OR=1.338,95%CI:1.147~1.561,P<0.001)、是否入住重症监护室(ICU)(OR=1.694,95%CI:1.230~2.333,P=0.001)、术前血红蛋白(OR=1.281,95%CI:1.016~1.616,P=0.036)、手术等待时间(OR=1.570,95%CI:1.063~2.319,P=0.023)、年龄(OR=2.196,95%CI:1.712~2.816,P<0.001)是老年股骨转子间骨折术后1年死亡的独立危险因素,依此建立的预测模型C-Index:建模组为0.769(95%CI:0.723~0.818),验证组为0.715(95%CI:0.612~0.750)。生存预测模型建模组和验证组的时间依赖性ROC曲线下面积分别为0.802(95%CI:0.722~0.850)和0.718(95%CI:0.640~0.808)。建模组和验证组校准曲线显示模型拟合度良好。DCA显示:该模型具有明显的正向获益,临床适用性良好。结论mFi-5、是否入住ICU、术前血红蛋白、手术等待时间、年龄是老年股骨转子间骨折术后1年死亡的独立预测因子,依此建立的预后模型,预测预后价值准确,有助于临床医师快速个体化评估,促进合理预期。Objective To investigate the risk factors associated with one-year mortality following surgery for intertrochanteric fractures in elderly patients and develop a survival prediction model.Methods A retrospective analysis was conducted on clinical data from 532 elderly patients with intertrochanteric fractures admitted to the People's Hospital of Xinjiang Uygur Autonomous Region and the People's Hospital of Xinyang between January 2020 and September 2022.Patient demographics,laboratory indicators,and surgical variables were documented.The primary outcome assessed was the one-year mortality rate.Risk factors were identified through univariate and multivariate Cox regression analyses,leading to the development of a prognostic model.The model's predictive performance was evaluated using the Concordance Index(C-Index),time-dependent receiver operating characteristic(ROC)curve,calibration curve,and decision curve analysis(DCA).Results Multivariate Cox regression analysis identified several key factors associated with one-year mortality after intertrochanteric fractures in elderly patients.These factors included the modified five-item frailty index(OR=1.338,95%CI:1.147-1.561,P<0.001),ICU admission(OR=1.694,95%CI:1.230-2.333,P=0.001),preoperative hemoglobin levels(OR=1.281,95%CI:1.016-1.616,P=0.036),surgical waiting time(OR=1.570,95%CI:1.063-2.319,P=0.023),and age(OR=2.196,95%CI:1.712-2.816,P<0.001).The prediction model showed good consistency with a C-Index of 0.769(95%CI:0.723-0.818)in the modeling group and 0.715(95%CI:0.612-0.750)in the validation group.Time-dependent ROC areas under the curve were 0.802(95%CI:0.722-0.850)and 0.718(95%CI:0.640-0.808)for the modeling and validation groups,respectively.Calibration curves for both groups indicated a good model fit,and decision curve analysis demonstrated a positive net benefit,highlighting the clinical applicability of the model.Conclusions The modified five-item frailty index,ICU admission,preoperative hemoglobin,surgical waiting time,and age independently predict one-y

关 键 词：骨折固定术 内 股骨骨折 死亡率 预后模型 

分 类 号：R687.3[医药卫生—骨科学]